Economical Value of Vaccines for the Developing Countries—The Case of Instituto Butantan, a Public Institution in Brazil

A recent review has discussed the economic value of vaccine for developed countries. The situation is quite different in developing countries, and we examine the situation in Brazil. Vaccines are of fundamental importance for the control of infectious diseases, especially among the population that lives in poor sanitary conditions. Also, vaccines can generate herd effects that result in protection even among those who have not been vaccinated, which can be of particular value to poor individuals who are not reached by health services. In appreciation of this importance, various international agencies, including the Pan American Health Organization (PAHO) and UNICEF, undertake large-scale procurement of vaccines for supply to developing countries. This scale of procurement has allowed these agencies to obtain very low prices. In Brazil, the Constitution includes the right to health care, which has led the government to formulate a goal of universal vaccination free of charge, a cost-effective measure against many important infectious diseases. Universal vaccination is a fundamental role of the federal, state, and municipal governments through the current unified public health care system (Sistema Único de Sáude [SUS]). To achieve this goal, in 1985 the Ministry of Health (MH) launched a national immunization program and a plan to achieve self-sufficiency in vaccine production through local institutions. The latter program included support for innovation and technological development. The success of this platform has allowed the MH to purchase vaccines from domestic public vaccine production institutes at prices comparable to those obtained by PAHO and UNICEF. Most of the research institutes in less developed countries (LDCs) are the descendants of the various Pasteur-like institutes founded in the early 1900s. Throughout their lives, these institutions maintained scientific research programs but had limited capability for meeting good manufacturing practices (GMPs) in vaccine production. The implementation of the MH policy of local procurement required substantial investments to upgrade the production capabilities of these institutes. The largest volume vaccine producer in Brazil is the Butantan Institute in São Paulo. The Institute, part of the São Paulo State Office of Health, was founded in 1901 to help in the control of bubonic fever and later became a producer of antivenoms and antitoxins. It maintains a scientific research program funded by grants from federal and state agencies. The administration of vaccine production is carried out by the Butantan Foundation, which is a separate, private, non-profit organization closely affiliated with the Institute (The Board of Directors of Butantan Institute and the Board of Curators of Butantan Foundation are composed of the same persons). Because of its legal structure, the Foundation is free of the usual administrative constraints of government agencies. In 2010, around 53 million doses of vaccine were used in the vaccination program implemented by the MH (Table 1). This comprises approximately 100 million doses of antigens, and of these, Butantan provided about 80%. The MH distributes vaccines free of charge to the whole country through about 25,000 health care centers, fulfilling a fundamental role of the SUS. The situation in Brazil contrasts with that of other developing countries. In India, private for-profit companies have emerged as the major vaccine producers. In China, the situation is mixed, with a number of government controlled nonprofit vaccine production institutes and several emerging private sector producers. The private Indian manufacturers have, in several cases, become major vaccine exporters and sell large quantities to UNICEF. The Chinese manufacturers have largely remained as suppliers for local needs. In both India and China, major developed country for-profit vaccine manufacturers are buying interests in the local companies. There are no private sector for-profit vaccine manufacturers in Brazil.