Home-Based Vaccination Records and Hypothetical Cost-Savings due to Avoidance of Re-Vaccinating Children

"As national immunization programmes, particularly those in low- and middle-income countries where administrative recording of services received is often absent or sub-optimal, enter a period of rapidly paced change with new vaccine introductions, it seems important to identify ways to avoid unnecessary re-vaccination of children..."

In this letter to the editor, researcher David W. Brown explores the role of the home-based vaccination record as what he finds to be a cost-effective communication strategy: "a point-of-care information resource to enhance health professionals' ability to make clinical decisions and prevent unnecessary repetition of vaccination..." Brown opines that vaccination cards "are far too often not printed and/or distributed, underutilized or inappropriately used by parents and health care workers and therefore do not always fulfil their intended purpose..." One reason for this, per Brown, is that short-run costs of printing childhood vaccination cards are often cited as an underlying reason for sub-optimal card stock availability.

Brown's research to address this issue involved computing an estimate of the potential cost savings due to avoidance of re-vaccinating children as a result of ensuring high prevalence of home-based vaccination records. To do so, the researchers considered a hypothetical cohort of 100,000 children, assuming that: all children survive to their first birthday; there is 100% card availability, compliance, and retention; and there is a cost per card of US$1 and a cost for a fully vaccinated child (FVC) of US$50 per child. Brown cites the Expanded Programme on Immunization (EPIs) definition of an FVC as a child who received Bacille Calmette-Guérin (BCG) vaccine, 3 doses of diphtheria-tetanus-pertussis (DTP) containing vaccine, 3 doses of polio vaccine, and 1 dose of measles containing vaccine per the national immunisation schedule in a given country. "As new vaccines have been added to this basic package, the definition of the fully vaccinated child has correspondingly changed by country, and continues to change."

In the base scenario, the cost of vaccinating 100,000 infants, assuming the conditions described above, the potential annual cost savings if a programme avoided re-vaccinating 20% of the birth cohort was US$750,000 at 75% FVC cost and US$500,000 at 50% FVC cost (detailed in Figure 1 and Table 1). The potential annual cost savings increased to US$2,500,000 at 100% FVC cost if the programme avoided re-vaccinating 50% of the cohort.

In conclusion, Brown argues that "home-based vaccination records offer an inexpensive and easily implemented option, particularly in low-resource settings and during a period of scarce resources where the potential cost savings achieved from the avoidance of re-vaccination is not to be overlooked." He also suggests that "further research is needed to better understand why some caregivers retain home-based vaccination records while others do not in order to inform potential programme changes, including improved communication and introduction of incentive structures."