Countries overstate immunization rates
Driven by incentives, poor nations exaggerate
WASHINGTON – Many of the world’s poorest countries have for decades routinely exaggerated the number of children being immunized against disease, apparently driven by political pressure and, more recently, financial incentives.
That is the finding of a huge analysis that has provoked heated discussion even before its publication Saturday in the Lancet, a European medical journal.
Since 1986, progress in childhood immunization in the developing world has been only half that officially reported by governments in the developing world. Not only are year-to-year improvements overstated, but the total percentage of children immunized is far lower than publicly acknowledged, the study found.
The two-decade trend masks extreme variations, with some countries overstating their gains four- and five-fold, and a few countries understating them.
The analysis – which compares official immunization coverage with what was found in house-to-house surveys – casts a shadow on the emerging strategy of “pay-for-performance” in global health assistance.
Specifically, it suggests that the pioneering Global Alliance on Vaccines and Immunizations may have paid out twice as much in performance rewards as it should have – $290 million instead of $150 million.
Of 51 countries that have received reward payments since GAVI was founded in 1999, six overestimated their immunization gains by a factor of four, 10 overestimated them by a factor of two, and 23 by less than two. Eight underestimated their progress.
GAVI has suspended reward payments to all countries, pending further review.
“By early next year, we will modify, drastically change, or possibly put in place a new system of incentive performance,” Julian Lob-Levyt, the executive director, said Thursday from London after a two-day meeting with GAVI’s partners to discuss the findings.
GAVI was started with a $750 million “seed grant” from the Bill and Melinda Gates Foundation. Ironically, the new analysis, done by a group of researchers at the University of Washington led by Christopher Murray, was also funded by the Gates Foundation.