The health ministry’s high-level committee has approved the introduction of pneumococcal conjugate vaccine (PCV) into the routine immunisation services. 

This means, the vaccine, which prevents transmission of pneumococcal bacterial diseases such as pneumonia, otitis media, bacteraemia and meningitis in children under 5 years will now be injected to children below one year. The ministry is planning to introduce the vaccine early next year. 

Health secretary Dr Ugen Dophu said the ministry wrote to the Bhutan Health Trust Fund (BHTF) on April 3 for budgetary support to introduce the vaccine into the routine immunisation services. “We are discussing with the BHTF on this.”

An economic evaluation was done with technical assistance from Health Intervention and Technology Assessment Programme in Thailand after the National Committee for Immunisation Practice recommended the ministry to introduce PCV into the routine immunisation services.

A study was conducted to determine the cost-utility and outcomes of 10 – and 12 –valent pneumococcal conjugate vaccines (PCV 10 and PCV 13) compared to no vaccination in Bhutan. 

The study recommended that both PC vaccines are cost effective and provide good value for money at the suggested threshold level of one GDP per capita equivalent to Nu 176,000. 

The study found that compared to no vaccination, implementing either of the vaccines would prevent an estimate of 2,003 and 2,916 episodes of pneumococcal disease in the vaccinated population. Further, 214 and 261 episodes of pneumococcal disease would be prevented in the unvaccinated populations due to herd protection.

The study also found that an estimate of 28 and 42 pneumococcal deaths would be averted by introducing PCV10 and PCV13, respectively.

It would cost about Nu 11.64M (million) to introduce PCV 13 into the routine immunisation services in the first year.

PCV 13 costs a little more than PCV 10. But, health officials said it yields better health outcomes. 

The budget analysis conducted over five year period considering the inclusion of PCV 10 or 13 in the routine immunisation services shows that about Nu 206.41M (million) is expected to be spent in the next five years as treatment cost of pneumonia and associated diseases if PCV vaccine is not introduced.

However, if introduced, the treatment cost is expected to decline by 8.5 percent and 13.6 percent respectively for PCV10 or PCV13.

In an earlier interview with Kuensel, director general of the department of medical services, Dr Pandup Tshering, said that the ministry first looks at the disease burden before introducing a vaccine. “Disease burden is based on the administrative data which means we are looking at people who visit the hospital and get treatment.”

According to the Annual Health Bulletin 2017, a total of 3,404 pneumonia cases were reported to the outpatient departments in all hospitals in 2016. Out of this, about 58 percent (1989) were in children below 5 years.

A total of 1,064 otitis media, an ear infection caused by pneumococcal bacteria outpatient cases were reported in children below 5 years. Of the total 160-inpatient cases with the infection, 53 were children below 5 years.

In 2016, about 198 meningitis/encephalitis inpatient cases were reported, out of which about 119 cases were in children below 5 years. A total of 3,150 pneumonia inpatient cases were reported the same year, of which, 2,117 were children below 5-years-old. 

Pneumonia has claimed 325 lives while 135 died of meningitis in the last five years. About 76 died of pneumonia and 47 of meningitis in 2016.

A laboratory officer with Essential Medicines and Technology Division (EMTD), Pempa in an earlier interview, said the government spends huge resources on treating of Pneumonia, Otitis Media and Meningitis, especially among the children. 

“If we implement PCV 13 we will be able to save more lives and the costs in long run,” he said.

 Dechen Tshomo