Second, the efficiency and effectiveness of government
AIDS vaccination campaigns will depend
critically on private individuals’ perceptions of the
vaccine, their willingness to be vaccinated, and their
ability and willingness to purchase vaccines. Understanding
individuals’ preferences is important information
for both: (1) the design of future vaccination
strategies; and (2) the study of volunteer preparedness
in AIDS vaccine trials. Thailand will face this issue
earlier, as it has and continues to play a key role in
large-scale efficacy trials.1 Tangcharoensathien et al.
[8] presented estimates of the potential government
demand for a preventive AIDS vaccine in Thailand.
The study assumed that for a vaccine that is 100%
efficacious and that conveys lifelong protection, the
government would target vaccination campaigns to the
highest risk individuals because of the substantial positive
externalities and impact on the overall epidemic.
The authors estimated that the government would
need to purchase 532,000 doses initially and would
require 15,000 doses annually to maintain vaccination
levels for eight target population groups.2 While
a useful start in terms of conceptualizing the government
response, this and other estimates of potential
public sector demand based on public health “need”
[9,10] assume that individuals offered a vaccine will
agree to be vaccinated. Yet, AIDS is a highly stigmatized
disease in most countries, so it is unlikely that
everyone would agree to be vaccinated, affecting the
coverage and effectiveness of a vaccination program.
The private demand for an AIDS vaccine has important
implications for improving the efficiency and effectiveness
of public programs. For individuals at high
risk of infection, the private benefits from an AIDS
vaccine are large—reduced risk of a disease that is
100% fatal and, up to now, incurable. Their proclivity
to independently seek out and purchase an AIDS vaccine
when it becomes available could reduce the burden
of the government in the difficult and costly task
of identifying high-risk groups for vaccination and allow
programs to focus on ensuring access to those
who cannot pay or on providing other cost-effective
interventions. Of equal concern to government is the
effect of the availability of an AIDS vaccine on risk
behavior in the population. Failure to adhere to safe
behavior once vaccinated with a less than completely
effective vaccine could eliminate or reverse the potential
benefits from a public vaccination program [6].
Second, the efficiency and effectiveness of governmentAIDS vaccination campaigns will dependcritically on private individuals’ perceptions of thevaccine, their willingness to be vaccinated, and theirability and willingness to purchase vaccines. Understandingindividuals’ preferences is important informationfor both: (1) the design of future vaccinationstrategies; and (2) the study of volunteer preparednessin AIDS vaccine trials. Thailand will face this issueearlier, as it has and continues to play a key role inlarge-scale efficacy trials.1 Tangcharoensathien et al.[8] presented estimates of the potential governmentdemand for a preventive AIDS vaccine in Thailand.The study assumed that for a vaccine that is 100%efficacious and that conveys lifelong protection, thegovernment would target vaccination campaigns to thehighest risk individuals because of the substantial positiveexternalities and impact on the overall epidemic.The authors estimated that the government wouldneed to purchase 532,000 doses initially and wouldrequire 15,000 doses annually to maintain vaccinationlevels for eight target population groups.2 Whilea useful start in terms of conceptualizing the governmentresponse, this and other estimates of potentialpublic sector demand based on public health “need”[9,10] assume that individuals offered a vaccine willagree to be vaccinated. Yet, AIDS is a highly stigmatizeddisease in most countries, so it is unlikely thateveryone would agree to be vaccinated, affecting thecoverage and effectiveness of a vaccination program.The private demand for an AIDS vaccine has importantimplications for improving the efficiency and effectivenessof public programs. For individuals at highrisk of infection, the private benefits from an AIDSvaccine are large—reduced risk of a disease that is100% fatal and, up to now, incurable. Their proclivityto independently seek out and purchase an AIDS vaccinewhen it becomes available could reduce the burdenof the government in the difficult and costly taskof identifying high-risk groups for vaccination and allowprograms to focus on ensuring access to thosewho cannot pay or on providing other cost-effectiveinterventions. Of equal concern to government is theeffect of the availability of an AIDS vaccine on riskbehavior in the population. Failure to adhere to safebehavior once vaccinated with a less than completelyeffective vaccine could eliminate or reverse the potentialbenefits from a public vaccination program [6].
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