The Potential Demand For And Strategic Use Of An Hiv 1 Vaccine In Southern India

Even a modestly effective HIV-1 vaccine would be highly useful in India and could avoid millions of deaths. How should such a vaccine be introduced? Based on evidence of adoption of other vaccines in India, current levels of spending on them and coverage of prevention programs targeting both high- and low-risk groups, Seshadri, Subramaniyam, and Jha assess the potential demand for and strategic use of an HIV-1 vaccine in the four southern Indian states of Andhra Pradesh, Karnataka, Maharashtra, and Tamil Nadu. The authors also discuss potential strategies for delivery of the vaccine, prioritization for vaccination, and the political economy of such a vaccine in India. Assuming a vaccine cost of $10 a dose and including estimated delivery costs, the total cost of vaccinating 21.6 million adolescents 11-14 years of age and 1 percent of adults would be Rs. 12.25 billion (US$ 245 million). To maintain the vaccination rate in the 11-14 year old cohort, an additional 6.77 million in that age range would have to be vaccinated each year, at a vaccine cost of Rs. 3.39 billion (US$ 67.5 million). An HIV-1 vaccine will greatly reduce HIV/AIDS in India, but it will not be a panacea. There will be a continued need for effective prevention programs to guard against behavior reversals or an imperfect vaccine. Key inputs for prevention, immunization, and treatment programs such as identification of various groups that could be immunized (vulnerable groups or general populations), strengthened surveillance, capacity building, operations research, and evaluation at local levels will continue to require intensive support. This paper--a product of Public Services, Development Research Group--is part of the research project on The Economics of an HIV/AIDS Vaccine in Developing Countries: Potential Impact, Cost-Effectiveness, and Willingness to Pay," sponsored by the European Commission and the Development Research Group of the World Bank. The project was launched in response to recommendations of the World Bank's AIDS Vaccine Task Force.

Even a modestly effective HIV-1 vaccine would be highly useful in India and could avoid millions of deaths. How should such a vaccine be introduced? Based on evidence of adoption of other vaccines in India, current levels of spending on them and coverage of prevention programs targeting both high- and low-risk groups, Seshadri, Subramaniyam, and Jha assess the potential demand for and strategic use of an HIV-1 vaccine in the four southern Indian states of Andhra Pradesh, Karnataka, Maharashtra, and Tamil Nadu. The authors also discuss potential strategies for delivery of the vaccine, prioritization for vaccination, and the political economy of such a vaccine in India. Assuming a vaccine cost of $10 a dose and including estimated delivery costs, the total cost of vaccinating 21.6 million adolescents 11-14 years of age and 1 percent of adults would be Rs. 12.25 billion (US$ 245 million). To maintain the vaccination rate in the 11-14 year old cohort, an additional 6.77 million in that age range would have to be vaccinated each year, at a vaccine cost of Rs. 3.39 billion (US$ 67.5 million).An HIV-1 vaccine will greatly reduce HIV/AIDS in India, but it will not be a panacea. There will be a continued need for effective prevention programs to guard against behavior reversals or an imperfect vaccine. Key inputs for prevention, immunization, and treatment programs such as identification of various groups that could be immunized (vulnerable groups or general populations), strengthened surveillance, capacity building, operations research, and evaluation at local levels will continue to require intensive support.This paper - a product of Public Services, Development Research Group - is part of the research project on The Economics of an HIV/AIDS Vaccine in Developing Countries: Potential Impact, Cost-Effectiveness, and Willingness to Pay, sponsored by the European Commission and the Development Research Group of the World Bank. The project was launched in response to recommendations of the World Bank's AIDS Vaccine Task Force.

How does economic geography influence industrial production and thereby affect industrial location decisions and the spatial distribution of development? For manufacturing industry, what are the externalities that matter, and to what extent? Are these externalities spatially localized? The authors answer these questions by analyzing the influence of economic geography on the cost structure of manufacturing firms by firm size for eight industry sectors in India. The economic geography factors include market access and local and urban externalities-which are concentrations of own-industry firms, concentrations of buyer-supplier links, and industrial diversity at the district (local) level. The authors find that industrial diversity is the only economic geography variable that has a significant, consistent, and substantial cost-reducing effect for firms, particularly small firms. This finding calls into question the fundamental assumptions regarding localization economies and raises further concerns on the industrial development prospects of lagging regions in developing countries.

The author aims to empirically determine the significant factors that affect the levels of budget deficits of central governments across time and across countries. He empirically tests two prominent theories of budget deficits-the Barro (1979) tax-smoothing approach, and the still-untested theory of negative bequest motives advocated by Cukierman and Meltzer (1989). The author uses econometric techniques including fixed-effects (both country and time) panel regressions spanning 87 countries over the period 1975 to 1992, and the Griliches treatment of missing data. The author finds relatively stronger statistical support for the tax-smoothing approach among developing countries but not in industrial countries. The existence of empirical evidence supporting the theory of negative bequest motives is indeterminate. The author also conducted post-regression analyses to assess the proportion of observed differences in budget deficits the factors were actually able to explain. These reveal that both theories are generally weak in accounting for inter-temporal changes in budget deficit shares for both industrial and developing countries. The theories performed significantly better in accounting for cross-section differences. The author has many contributions to the literature. First, he analyzes the question of what determines the size of central government budget deficits using cross-country time series data leading into the 1990s. Second, he provides empirical tests of the still-untested Cukierman-Meltzer (1989) negative bequest motive theory of budget deficits. By using the panel data, the author attempts to determine the factors that influence not only the inter-temporal differences in budget deficits but also those factors that lead to cross-country differences. Last but not least, he provides some preliminary evidence that poverty reduction is necessary for long-term government budget deficit reduction.

The debate on fiscal policy in Europe centers on how to let automatic stabilizers work while achieving fiscal consolidation. There is significant agreement on the importance of using fiscal policy as a counter-cyclical instrument, as monetary policy can no longer play this role. In contrast, most of the discussion on fiscal policy in Latin America and the Carribean region (LAC) deals just on solvency issues, largely ignoring the effects of the economic cycle. This is surprising as LAC economies are much more volatile than their European counterparts and have been generally applying pro-cyclical fiscal policies that exacerbate volatility. Some analysts and policymakers appear to think that counter-cyclical fiscal policies are a luxury that only industrial countries can indulge in or, at least, that LAC countries (with the exception of Chile) that have successfully put in place a counter-cyclical fiscal policy need to deal first with pressing adjustment and solvency issues before they attempt to reduce the highly pro-cyclical character of their fiscal policies. The author argues that this is a major mistake because the costs of pro-cyclical fiscal policies in LAC are huge in growth and welfare terms, especially for the poor, and because pro-cyclical policies and rules tend to develop a deficit bias, thus ending up being nonsustainable and noncredible. Perry illustrates both propositions. He then examines the causes of the pro-cyclicality of fiscal policies in LAC and discusses how well-designed fiscal rules may help to deal with the political economy and credibility factors behind pro-cyclicality. He also examines conflicts between flexibility and credibility in rules, showing how a good design can both facilitate the operation of automatic stabilizers while at the same time supporting solvency goals and enhancing credibility. Perry evaluates the experience with different fiscal rules and institutions in LAC to see the extent they have helped or can help to achieve the twin goals of avoiding deficit and pro-cyclical biases.

Pension systems may have a different impact on gender because women are less likely than men to work in formal labor markets and earn lower wages when they do. Recent multipillar pension reforms tighten the link between payroll contributions and benefits, leading critics to argue that they will hurt women. In contrast, supporters of these reforms argue that it will help women by the removal of distortions that favored men and the better targeted redistributions in the new systems. To test these conflicting claims and to analyze more generally the gender effect of alternative pension systems, James, Edwards, and Wong examine the differential impact of the new and old systems in three Latin American countries--Argentina, Chile, and Mexico. Based on household survey data, they simulate the wage and employment histories of representative men and women, the pensions they are likely to generate under the new and old rules, and the relative gains or losses of men and women because of the reform. The authors find that women do accumulate private annuities that are only 30-40 percent those of men in the new systems. But this effect is mitigated by sharp targeting of the new public pillars toward low earners, many of whom are women, and by restrictions on payouts from the private pillars, particularly joint annuity requirements. As a result of these transfers, total lifetime retirement benefits for women reach 60-80 percent those of men, and for "full career" women they equal or exceed benefits of men. Also as a result, women are the biggest gainers from the pension reform. For women who receive these transfers, female/male ratios of lifetime benefits in the new systems exceed those in the old systems in all three countries. Private intra-household transfers from husband to wife in the form of joint annuities play the largest role. This paper is a product of the Gender Division, Poverty Reduction and Economic Management Network.

In 1986 Vietnam initiated a transition from a centrally planned economy to a market-oriented economy where the government would keep playing a leading role. These renovation (doi moi) policies were successful at generating economic growth and reducing poverty. In the ten-year socioeconomic strategy endorsed by the Ninth Party Congress in April 2001, the authorities further articulated their development objectives in terms of economic growth and poverty reduction. To reach these objectives, the government indicated that its structural reform priorities were to change Vietnam's trade and financial policies, liberalize the climate for private investment, increase the efficiency of public enterprises, and improve governance. The author argues that the pace of implementation of trade reform-which has been impressive so far-is raising new challenges. On one side, fast liberalization of trade reform may soon conflict with the slow pace of implementation of other reforms, including restructuring of state-owned enterprises and state-owned commercial banks. On the other side, Vietnam would greatly benefit from fast implementation of trade reform and particularly fast accession to the World Trade Organization (WTO), especially after China's recent WTO accession. Auffret concludes that implementation of trade reform will be a testing ground to reveal the extent of Vietnam's commitment to a market-oriented economy.