Haemophilus influenzae type b (Hib) causes millions of cases of serious illness worldwide and hundreds of thousands of death each year, chiefly through meningitis and pneumonia. Almost all victims are children under the age of five in developing countries. Children who survive Hib disease suffer life-long damage such as blindness, deafness, brain damage or paralysis.

The best way to protect babies against Hib is through vaccination. But various obstacles prevent uptake of Hib vaccine in the developing world. These include a lack of information regarding the disease or the disease burden as well as inadequate funding. Hib is more expensive than classic childhood vaccines, costing roughly seven times the total cost of vaccines against measles, polio, tuberculosis, diphtheria, tetanus, and pertussis.

These challenges put developing countries in a difficult situation. Before adding a costly vaccine to infant immunization programs, they want evidence of the extent and damage done by Hib, the impact of Hib vaccine on meningitis and pneumonia rates, and the long-term economic benefits and costs of the vaccine. Yet this information, which is necessary for making informed policy decisions, has rarely been measured in the developing world.

To better understand Hib disease epidemiology and the costs and benefits of introducing the Hib vaccine in Indonesia, AMP worked with national health authorities on a probe study from 1997-2002. The aim of the research was to determine the incidence of Hib-related diseases throughout Indonesia as well as the cost-effectiveness of vaccination.

The study, a collaborative effort between AMP, the Indonesian Ministry of Health, the West Nusa Tengarra Provincial Health Department, PATH, and the Johns Hopkins Bloomberg School of Public Health, involved children from the island of Lombok. A control group was given Sanofi Pasteur’s tetract-Hib vaccine (DTwP-PRP-T). Cost was assessed by recording actual hospitalization costs, conducting a drug use survey, and interviewing parents on pre- and post-hospitalization costs.