Budget plan for the immunization program

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THE The National Immunization Program (NIP) is likely to extend until 2022 given immunological uncertainties such as potential reduction in vaccine efficacy against Delta and future variants, decline in immunity, uneven level protection against different types of vaccines and the high infectivity rate of the variants.

As a result, we must ensure a high level of immunization preparedness and carry out the necessary studies to better inform ourselves about the state of the health crisis. Therefore, it is proposed to increase the PIN from 5 billion ringgit this year to 6.115 billion ringgit by 2022.

The key items that would see an increase would be vaccine procurement, post-vaccination surveillance, outsourcing of private doctors, and contingencies.

The infrastructure for data integration systems has been established, therefore the allocation for next year will see a reduction, although some upgrades are required. Other components of the NIP can be maintained, resulting in a net increase of 1.115 billion ringgit.

Sub-items worth RM3.5 billion allocated to vaccine supply and logistics (for the Covid-19 vaccine portfolio) may not (in 2021) account for vaccines such as Sputnik V and CanSino, and it is prudent to allocate for boosters and / or updated vaccines.

With a greater number of vaccines approved by the National Drug Regulatory Agency and the potential for a greater number of nucleotide-type vaccines compared to deactivated vaccine types, a higher overall cost is expected. Therefore, an additional 1 billion ringgit is proposed for this sub-item, bringing it to 4.5 billion ringgit.

Going forward, the government should embark on decentralization strategies by designating nationwide general practitioner (GP) clinics and private hospitals as vaccination centers. Therefore, it is necessary to take into account the costs of equipping selected general practitioners with the necessary storage and handling capacity for certain types of vaccines, while mega vaccination centers (PPVs) could be reserved for specific circumstances. particular.

At an endemic stage, where people are more likely to be infected sooner or later, some of these people may have health risk factors they are not aware of that could push their symptoms to more severe stages. .

Thus, it is crucial to have a locally assigned general practitioner to monitor positive cases in his vicinity to avoid unattended disease progression, which could have contributed to the recent increase in reported death cases. These should also be the same general practitioner authorized for future vaccination and health crises. It is proposed to increase the 210 million ringgit previously allocated to the outsourcing of private physicians by 40 million ringgit.

The previous allocation of RM 15 million for post-vaccination surveillance appears to be grossly under-budgeted. It is proposed to increase both genomic analysis and serological studies to 3% of cases (from 1%), as it is important to understand the immunological uncertainties of natural and vaccine-induced immunity, and the viral variants.

This is crucial for providing information on the validity of vaccination certificates and can offer information on vaccine procurement strategies, better treatment for severe cases, and prevention of disease progression.

Considering its importance, an increase of RM 45 million should be considered, bringing the budget allocation to RM 60 million, as the increase in throughput needs to be met through significant improvements in laboratory capacity. Part of this sum should be allocated to monitoring other reservoirs of viruses (pediatric and zoological).

Room rental and utilities allowances amounting to RM 333 million totaled 600 PPV. While it is expected that there will be a reduction in rental costs in line with the reduced number of mega PPVs, distributed logistics for special vaccines and GP empowerment can compensate for this.

In the future, school rooms should be used as a “mega” PPV if needed, which should not result in much lower rental fees and utility costs. Overall, the allocation of RM 333 million is expected to remain as it is.

The other elements of the line remain unchanged. For example, equipment and consumables should see a potential reduction in expenses as it is expected that most of this equipment could still be used in 2022. However, the cost of its implementation in private GP clinics, institutions health and the proposed use of school rooms as immunization centers can offset the cost.

The same or similar allowance for cleaning, disinfection and non-clinical waste disposal, as well as allowances for the gratification of health and other volunteers are reasonably expected.

Although there may be a reduced need for immunization awareness and advocacy programs, this cost could be offset by the expenses required to empower local health centers such as hospitals or general medicine clinics in areas. rural. As data integration and appointment systems have been put in place, it is proposed to reduce the allocation from Ringgit 70 million to Ringgit 20 million. Therefore, the 2022 allocation of RM 50 million is proposed for the relaunch (and potential overhaul) of the advanced predictive hot spot identification system for dynamic engagement and upgrading of the MySejahtera app with better contact tracing technology that could also be useful in future outbreaks.

Upgrading MySejahtera with a “MyGP” function should also be considered as part of the strategy of decentralizing the monitoring and delivery of health care at the community level by a local general practitioner or designated health professionals.

Based on the 2021 experience and considerable future uncertainties, an additional allocation of RM 50 million is proposed for contingencies, bringing it to RM 160 million, subject to the approval of the Ministry of Finance. Thus, the net impact on the NIP budget allocation in 2022 is an increase of 1.115 billion ringgit, bringing the total budget to 6.115 billion ringgit.

The previous commitment to Covax should also be revised, and the authorities should
reconsider whether further commitments in 2022 would be justified, based on experience. It was previously estimated at 3 billion ringgit, which is a substantial amount that could be
reallocated to increase allocations in the NIP, or in the health budget.

Ameen Kamal is the head of science and technology at EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research. Comments: [email protected]


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