Achieving Excellence in Sustainable Development Goals …
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efficacy of GM OX513A male mosquitoes as a mosquito control measure. Extensive
simulations concluded that OX513A mosquitoes will not be effective in controlling
wild mosquito population as a vector control measure (Koh et al. 2011). For sure,
GM mosquito field release is very expensive, is not sustainable economically and
not feasible logistically. The authors recommended that the GM release experiments
in Malaysia be terminated. By mid-2015, the minister of MOH decided to terminate
this experimental study, citing similar reasons. The GM mosquito release can only
control mosquito population over a small area, while dengue is everywhere, the
minister declared. To be useful as a vector control measure, the GM mosquitoes
must be released across very large areas over an extended period. This will impose
immense financial burdens far beyond the capability of the government, and is not
consistent with SDG 3. Further, the ecological impacts have never been studied at
all, contradicting SDG 15.
Because effective mosquito control has been proven to be difficult to sustain,
dengue vaccine is highly desirable in an environment of persistent dengue epidemic.
However, the vaccine must be safe, socially equitable, affordable, cost-effective and
efficacious. Price is the most important factor influencing vaccine sustained adoption
in low and medium income countries (LMIC), once safety and efficacy are assured.
An extensive literature review reveals that (a) most vaccines are affordable, readily
accepted, and sustainably adopted if they are priced below USD 1.00 in LMIC and
that (b) dengue vaccine can be sustainably produced at around USD 0.50 per dose
with mass production (Mahoney et al. 2012). As the developing LMIC countries find
it increasing difficult to cope, sound economic fundamental is essential in justifying
pricing decisions to introduce and sustain vaccination (Beatty et al. 2011). A WHO
study found that vaccine is cost-effective in developed countries at the price of USD
7.64 per dose, weighted average for public and private sector including administrative costs (Beatty et al. 2011). The fair price threshold for LMIC should therefore
be much lower. Another recent study in Singapore concluded that a dengue vaccine
involving three doses and conferring ten years of immunity would be cost-effective
at a price threshold of USD 95 per dose, given Singapore GDP per capita of about
USD 55,000 (Carrasco et al. 2011). Whether this high price threshold is affordable or
socially equitable for Singapore was not a concern for the researchers. This attitude
contradicts the aspiration of SDG 3 that aims to sustain good health for all. It is undeniable that this price threshold of USD 95 per dose is not affordable and not socially
equitable for Malaysia, given the much lower GPD per capita of USD 11,000 for
Malaysia. To subscribe to the aspiration of SDG 3, the study team devised a combination of five criteria mentioned earlier as a basis for a transparent valuation of threshold
price. The study concludes that a socially equitable and highly cost-effective price
threshold in Malaysia for dengue vaccine is USD 5 per dose (Koh et al. 2017). This
socially equitable price threshold will be widely affordable to and readily adopted by
the Malaysian consumers. This will ensure sustained and predictable consumption,
which in turn will allow producers to fine-tune mass production to reduce the costs
of production and distribution to less than USD 1.00 per dose. This will be a win-win
scenario for both consumers and vaccine developers. Further, the study team has
discovered that the current version of Dengvaxia has a hidden danger (Koh et al.
269
efficacy of GM OX513A male mosquitoes as a mosquito control measure. Extensive
simulations concluded that OX513A mosquitoes will not be effective in controlling
wild mosquito population as a vector control measure (Koh et al. 2011). For sure,
GM mosquito field release is very expensive, is not sustainable economically and
not feasible logistically. The authors recommended that the GM release experiments
in Malaysia be terminated. By mid-2015, the minister of MOH decided to terminate
this experimental study, citing similar reasons. The GM mosquito release can only
control mosquito population over a small area, while dengue is everywhere, the
minister declared. To be useful as a vector control measure, the GM mosquitoes
must be released across very large areas over an extended period. This will impose
immense financial burdens far beyond the capability of the government, and is not
consistent with SDG 3. Further, the ecological impacts have never been studied at
all, contradicting SDG 15.
Because effective mosquito control has been proven to be difficult to sustain,
dengue vaccine is highly desirable in an environment of persistent dengue epidemic.
However, the vaccine must be safe, socially equitable, affordable, cost-effective and
efficacious. Price is the most important factor influencing vaccine sustained adoption
in low and medium income countries (LMIC), once safety and efficacy are assured.
An extensive literature review reveals that (a) most vaccines are affordable, readily
accepted, and sustainably adopted if they are priced below USD 1.00 in LMIC and
that (b) dengue vaccine can be sustainably produced at around USD 0.50 per dose
with mass production (Mahoney et al. 2012). As the developing LMIC countries find
it increasing difficult to cope, sound economic fundamental is essential in justifying
pricing decisions to introduce and sustain vaccination (Beatty et al. 2011). A WHO
study found that vaccine is cost-effective in developed countries at the price of USD
7.64 per dose, weighted average for public and private sector including administrative costs (Beatty et al. 2011). The fair price threshold for LMIC should therefore
be much lower. Another recent study in Singapore concluded that a dengue vaccine
involving three doses and conferring ten years of immunity would be cost-effective
at a price threshold of USD 95 per dose, given Singapore GDP per capita of about
USD 55,000 (Carrasco et al. 2011). Whether this high price threshold is affordable or
socially equitable for Singapore was not a concern for the researchers. This attitude
contradicts the aspiration of SDG 3 that aims to sustain good health for all. It is undeniable that this price threshold of USD 95 per dose is not affordable and not socially
equitable for Malaysia, given the much lower GPD per capita of USD 11,000 for
Malaysia. To subscribe to the aspiration of SDG 3, the study team devised a combination of five criteria mentioned earlier as a basis for a transparent valuation of threshold
price. The study concludes that a socially equitable and highly cost-effective price
threshold in Malaysia for dengue vaccine is USD 5 per dose (Koh et al. 2017). This
socially equitable price threshold will be widely affordable to and readily adopted by
the Malaysian consumers. This will ensure sustained and predictable consumption,
which in turn will allow producers to fine-tune mass production to reduce the costs
of production and distribution to less than USD 1.00 per dose. This will be a win-win
scenario for both consumers and vaccine developers. Further, the study team has
discovered that the current version of Dengvaxia has a hidden danger (Koh et al.