WHO PAYS FOR MEASLES - THE ECONOMIC ARGUMENTS FOR SUSTAINED IMMUNIZATION

Increasing international commitment to Universal Child Immunization (UCI) intensifies pressures on already scarce health resources. The costs of the 1989/90 measles epidemic were measured in the State of Guerrero, Mexico, from the perspective of the health services and 43 representative communities. Financial loss was incurred from illness in families of 70% of the 1211 measles cases in a study population of 50 294. Some 30% of these families did not have sufficient cash reserves and sold labour, farm animals or other assets. Among those families, 20% took loans in order to pay the health care costs of their children's measles, 19% sold grain stores and 4% indentured their future labour. Standardizing household expenditure on local labour costs, it was possible to quantify out-of-pocket expenditure and loss of work time. The average cost of a measles case to the community amounted to the local equivalent of 18.8 work days of an unskilled labourer, with 27 work days per household affected, excluding income foregone due to early deaths. Hastings and colleagues calculated the average cost of measles to British families in 1985 to be 11.09 UK Pounds, considerably less than a day's wage for a British unskilled labourer at that time. Applying the costs in the 43 communities to the whole State of Guerrero, without placing a cash value on some 4000 children aged under five who died from measles, the epidemic cost the community the equivalent of 1.6 million work days. The health services spent 10% of this value on the epidemic. The cost of vaccinating all children in the State could be sustained for five years, and increase by 10% per year, and it would still be lower than the economic cost of an epidemic to the communities.