A cost-effectiveness analysis of revaccination and catch-up strategies with the 23-valent pneumococcal polysaccharide vaccine (PPV23) in older adults in Japan

Objective: In Japan, the National Immunization Program (NIP) includes PPV23 as the primary vaccination for adults and catch-up cohorts. The Japanese Association for Infectious Diseases recommends revaccination for older adults who received primary vaccination ≥5 years earlier. The cost-effectiveness of adding revaccination and/or continuing catch-up vaccination in the NIP was evaluated from the public payer perspective in Japan.

Methods: The Markov model included five health states: no pneumococcal disease, invasive pneumococcal diseases (IPD), non-bacteremic pneumococcal pneumonia (NBPP), post-meningitis sequelae, and death. Cohorts of adults aged 65–95 were followed until age 100 or death: 2014 cohort (aged 65–95, vaccinated: 2014); 2019 cohort (aged 65: 2019); and 2019 catch-up cohort (aged 70–100: 2019, unvaccinated: 2014). Strategies included: (1) vaccinate 2014 and 2019 cohorts; (2) vaccinate 2014 and 2019 cohorts and revaccinate both; (3) strategy 1 and vaccinate 2019 catch-up cohort; (4) strategy 2 and vaccinate 2019 catch-up cohort; and (5) strategy 4 and revaccinate 2019 catch-up cohort. Parameters were retrieved from global and Japanese sources, costs and QALYs discounted at 2%, and incremental cost-effectiveness ratios (ICERs) estimated.

Results: Strategy 1 had the highest number of IPD and NBPP cases, and strategy 5 the lowest. Strategies 3–5 dominated strategy 1 and strategy 2 was cost-effective compared to strategy 1 (ICER: ¥1,622,153 per QALY gained). At a willingness-to-pay threshold of ¥5 million per QALY gained, strategy 2 was cost-effective and strategies 3–5 were cost-saving compared to strategy 1.

Conclusions: Strategies including revaccination, catch-up, or both were cost-effective or cost-saving in comparison to no revaccination and no catch-up. Results can inform future vaccine policies and programs in Japan.     

Financial Market Fragmentation and Reforms in Ghana, Malawi, Nigeria, and Tanzania

This article reports the findings from surveys of formal andinformal institutions and their clients in Ghana, Malawi, Nigeria,and Tanzania. It investigates the hypothesis that reformingfinancially repressive policies would not be sufficient to overcomefragmentation of financial markets because of structural andinstitutional barriers to interactions across different marketsegments. The four countries have substantially fragmented financialmarkets, with weak linkages between formal and informal segmentsand interest rate differentials that cannot be adequately explainedby differences in costs and risks. Nevertheless, the relativelylow transaction costs and loan losses of informal institutionsindicate that they provide a reasonably efficient solution toinformation, transaction cost, and enforcement problems thatexclude their clients from access to formal banking services.The findings imply that financial liberalization and bank restructuringin the African context should be accompanied by complementarymeasures to address institutional and structural problems, suchas contract enforcement and information availability, and toimprove the integration of informal and formal financial markets.     

Financing enterprise development in sub-Saharan Africa

This paper examines some critical gaps in the financial infrastructurein sub-Saharan Africa, which have contributed to the poor performanceof productive investment by private agents. It first analysesthe performance of financial systems, encompassing both formaland informal financial sectors, in relation to the changingpolicy environment, and key features of the financial marketstructure. It then identifies those gaps in financial servicesthat have been particularly detrimental to private investment,enterprise growth and transformation. Finally, the paper considerspolicy implications drawn from East Asian experiences with respectto financial policies, institutional arrangements and marketintegration measures for financing enterprise development.     

An interactive decision stratum for the multilevel world model

A world model being developed by the authors for the Club of Rome is described. It is based on an interaction between man—the decision maker or the policy analyst-and the computer. Such a symbiosis avoids the pitfalls of relying solely on the computer for policy analysis, which by necessity leads to a mechanistic view of the situation; it provides also means for a creative use of computer techniques for extending the logical capability of man in long-term planning and analysis while leaving the ultimate responsibility for prediction, planning and decision making in his hands. The model is multilevel and hierarchical, with the world represented not as an aggregate, but as a number of regions with countries grouped according to economic similarity.     

Motivations for aid to developing countries

This paper attempts to identify the underlying principles of aid allocation, and particularly the balance of motivations as between the needs of recipient countries and the interests of donor countries. Two alternative models are fitted by cross-country regressions to bilateral and multilateral aid flows to some 80 developing countries in 1969–1970 and 1978–1980. The first (recipient need) model assumes that all aid is given to compensate for shortfalls in domestic resources. This model provides a reasonable explanation for the distribution of multilateral aid, but it is clearly not applicable for bilateral aid flows. The second (donor interest) model assumes that all aid serves only donor interests, defined to cover political/security investment and trade interests. This model gives generally good explanations of bilateral aid, but is a poor fit for multilateral aid. The relative importance of the various donor interests differs sharply among donors. The paper ends with an analysis of the shift in the balance of aid over the 1970s towards the recipient need element, and with a reference to the sharp change in policy in the 1980s towards increasing emphasis on donor interest aid.     

Peliosis of the spleen with intraperitoneal hemorrhage

We encountered a patient with steroidrelated peliosis of the spleen, a rare disease characterized by multiple blood-filled cavities in the splenic parenchyma, with spontaneous intraperitoneal hemorrhage. The ultrasonographic, computed tomographic, and angiographic images were compared with pathologic findings of the material obtained surgically.     

Cultural differences in perceptions of environmental problems

A comparative survey study of environmental perceptions and beliefs was conducted in Japan and in two New York State countries in 1974. While the samples and the instruments were not strictly comparable, there was sufficient comparability to compare perceptions about the seriousness of the environmental problem, perceptions of the quality of various environmental elements, the definition of the environmental problem, the causes of the environmental problem, attitudes toward governmental action to solve environmental problems, and citizen activity with respect to the environmental problem. Some general findings are that the definition of the environmental problem is culture bound. That we cannot expect people to support strong environmentally protective actions by governments until they perceive a clear and present danger. That if people perceive environmental damage to be caused by the social, economic, and political system, they will look to the system for the solution and will take little personal action to alleviate the problem. We had held a hope that mankind might take a more thoughtful and planned approach to a new environmentally protective social order; this hope received little encouragement from what we have learned in this study.     

Institutional Foundations for Shared Growth in Sub‐Saharan Africa*

Abstract: The paper examines the dynamically evolving triangular relationships between institutions, growth and inequality in the process of economic development, in order to deepen the understanding of institutional conditions for pro‐poor growth and shared growth. In this context, the paper discusses the institutional conditions found in sub‐Saharan Africa, which may have produced the growth pattern that is unequal and against the poor. The analysis shows that sub‐Saharan African countries require transforming institutions for embarking upon and sustaining a development path which would ensure shared growth in years to come. The paper first evaluates the growth‐inequality‐poverty nexus, as found in the recent literature, which increasingly challenges the trade‐off between growth and equity, as postulated in the traditional theories. Various definitions of pro‐poor growth are discussed and a sharper definition of the concept of ‘shared’ growth is provided. Definitions of institutions are then examined, as well as the triangular inter‐relationships between institutions, inequality and poverty. The paper finally analyses specific institutional conditions found in sub‐Saharan Africa that prevent economies from emerging out of low‐equilibrium poverty traps that are characterized by low economic growth, unequal distribution of income and wealth as well as unequal access to resources and power.