1
|
Mak J, Patenaude BN, Mutembo S, Pilewskie ME, Winter AK, Moss WJ, Carcelen AC. Modeling the Cost of Vaccinating a Measles Zero-Dose Child in Zambia Using Three Vaccination Strategies. Am J Trop Med Hyg 2024; 111:121-128. [PMID: 38772386 PMCID: PMC11229634 DOI: 10.4269/ajtmh.23-0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 02/10/2024] [Indexed: 05/23/2024] Open
Abstract
Countries with moderate to high measles-containing vaccine coverage face challenges in reaching the remaining measles zero-dose children. There is growing interest in targeted vaccination activities to reach these children. We developed a framework for prioritizing districts for targeted measles and rubella supplementary immunization activities (SIAs) for Zambia in 2020, incorporating the use of the WHO's Measles Risk Assessment Tool (MRAT) and serosurveys. This framework was used to build a model comparing the cost of vaccinating one zero-dose child under three vaccination scenarios: standard nationwide SIA, targeted subnational SIA informed by MRAT, and targeted subnational SIA informed by both MRAT and measles seroprevalence data. In the last scenario, measles seroprevalence data are acquired via either a community-based serosurvey, residual blood samples from health facilities, or community-based IgG point-of-contact rapid diagnostic testing. The deterministic model found that the standard nationwide SIA is the least cost-efficient strategy at 13.75 USD per zero-dose child vaccinated. Targeted SIA informed by MRAT was the most cost-efficient at 7.63 USD per zero-dose child, assuming that routine immunization is just as effective as subnational SIA in reaching zero-dose children. Under similar conditions, a targeted subnational SIA informed by both MRAT and seroprevalence data resulted in 8.17-8.35 USD per zero-dose child vaccinated, suggesting that use of seroprevalence to inform SIA planning may not be as cost prohibitive as previously thought. Further refinement to the decision framework incorporating additional data may yield strategies to better target the zero-dose population in a financially feasible manner.
Collapse
Affiliation(s)
- Joshua Mak
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Bryan N Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Simon Mutembo
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Monica E Pilewskie
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Amy K Winter
- Department of Epidemiology & Biostatistics, University of Georgia College of Public Health, Athens, Georgia
| | - William J Moss
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrea C Carcelen
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
2
|
Bilgin GM, Munira SL, Lokuge K, Glass K. Cost-effectiveness analysis of a maternal pneumococcal vaccine in low-income, high-burden settings such as Sierra Leone. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000915. [PMID: 37619237 PMCID: PMC10449127 DOI: 10.1371/journal.pgph.0000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/01/2023] [Indexed: 08/26/2023]
Abstract
Maternal pneumococcal vaccines have been proposed as a method of protecting infants in the first few months of life. In this paper, we use results from a dynamic transmission model to assess the cost-effectiveness of a maternal pneumococcal polysaccharide vaccine from both healthcare and societal perspectives. We estimate the costs of delivering a maternal pneumococcal polysaccharide vaccine, the healthcare costs averted, and productivity losses avoided through the prevention of severe pneumococcal outcomes such as pneumonia and meningitis. Our model estimates that a maternal pneumococcal program would cost $606 (2020 USD, 95% prediction interval 437 to 779) from a healthcare perspective and $132 (95% prediction interval -1 to 265) from a societal perspective per DALY averted for one year of vaccine delivery. Hence, a maternal pneumococcal vaccine would be cost-effective from a societal perspective but not cost-effective from a healthcare perspective using Sierra Leone's GDP per capita of $527 as a cost-effectiveness threshold. Sensitivity analysis demonstrates how the choice to discount ongoing health benefits determines whether the maternal pneumococcal vaccine was deemed cost-effective from a healthcare perspective. Without discounting, the cost per DALY averted would be $292 (55% of Sierra Leone's GDP per capita) from a healthcare perspective. Further, the cost per DALY averted would be $142 (27% GDP per capita) from a healthcare perspective if PPV could be procured at the same cost relative to PCV in Sierra Leone as on the PAHO reference price list. Overall, our paper demonstrates that maternal pneumococcal vaccines have the potential to be cost-effective in low-income settings; however, the likelihood of low-income countries self-financing this intervention will depend on negotiations with vaccine providers on vaccine price. Vaccine price is the largest program cost driving the cost-effectiveness of a future maternal pneumococcal vaccine.
Collapse
Affiliation(s)
- Gizem M. Bilgin
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Syarifah Liza Munira
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Kamalini Lokuge
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Kathryn Glass
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| |
Collapse
|
3
|
Levin A, Burgess C, Shendale S, Morgan W, Cw Hutubessy R, Jit M. Cost-effectiveness of measles and rubella elimination in low-income and middle-income countries. BMJ Glob Health 2023; 8:e011526. [PMID: 37429697 PMCID: PMC10335502 DOI: 10.1136/bmjgh-2022-011526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/10/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Since 2000, the incidence of measles and rubella has declined as measles-rubella (MR) vaccine coverage increased due to intensified routine immunisation (RI) and supplementary immunisation activities (SIAs). The World Health Assembly commissioned a feasibility assessment of eliminating measles and rubella. The objective of this paper is to present the findings of cost-effectiveness analysis (CEA) of ramping up MR vaccination with a goal of eliminating transmission in every country. METHODS We used projections of impact of routine and SIAs during 2018-2047 for four scenarios of ramping up MR vaccination. These were combined with economic parameters to estimate costs and disability-adjusted life years averted under each scenario. Data from the literature were used for estimating the cost of increasing routine coverage, timing of SIAs and introduction of rubella vaccine in countries. RESULTS The CEA showed that all three scenarios with ramping up coverage above the current trend were more cost-effective in most countries than the 2018 trend for both measles and rubella. When the measles and rubella scenarios were compared with each other, the most cost-effective scenario was likely to be the most accelerated one. Even though this scenario is costlier, it averts more cases and deaths and substantially reduces the cost of treatment. CONCLUSIONS The Intensified Investment scenario is likely the most cost-effective of the vaccination scenarios evaluated for reaching both measles and rubella disease elimination. Some data gaps on costs of increasing coverage were identified and future efforts should focus on filling these gaps.
Collapse
Affiliation(s)
- Ann Levin
- Levin & Morgan LLC, Bethesda, Maryland, USA
| | | | | | | | | | - Mark Jit
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
4
|
Getchell M, Mantaring EJ, Yee K, Pronyk P. Cost-effectiveness of sub-national geographically targeted vaccination programs: A systematic review. Vaccine 2023; 41:2320-2328. [PMID: 36781333 DOI: 10.1016/j.vaccine.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/19/2023] [Accepted: 02/03/2023] [Indexed: 02/13/2023]
Abstract
Immunization is an essential component of national health plans. However, the growing number of new vaccine introductions, vaccination campaigns and increasing administrative costs create logistic and financial challenges, especially in resource-limited settings. Sub-national geographic targeting of vaccination programs is a potential strategy for governments to reduce the impact of infectious disease outbreaks while optimizing resource allocation and reducing costs, promoting sustainability of critically important national immunization plans. We conducted a systematic review of peer-reviewed literature to identify studies that investigated the cost-effectiveness of geographically targeted sub-national vaccination programs, either through routine immunization or supplementary immunization activities. A total of 16 studies were included in our review, covering nine diseases of interest: cholera, dengue, enterotoxigenic Escherichia coli (ETEC), hepatitis A, Japanese encephalitis, measles, rotavirus, Shigella and typhoid fever. All studies modelled cost-effectiveness of geographically targeted vaccination. Despite the variation in study design, disease focus and country context, studies generally found that in countries where a heterogenous burden of disease exists, sub-national geographic targeting of vaccination programs in areas of high disease burden was more cost-effective than a non-targeted strategy. Sensitivity analysis revealed that cost-effectiveness was most sensitive to variations in vaccine price, vaccine efficacy, mortality rate, administrative and operational costs, discount rate, and treatment costs. This systematic review identified several key characteristics related to geographic targeting of vaccination, including the vaccination strategy used, variations in modelling parameters and their impact on cost-effectiveness. Additional research and guidance is needed to support the appropriateness and feasibility of geographically targeted vaccination and to determine what country context would make this a viable complement to routine immunization programs.
Collapse
Affiliation(s)
- Marya Getchell
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
| | | | - Kaisin Yee
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Paul Pronyk
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| |
Collapse
|
5
|
Chatterjee S, Song D, Das P, Haldar P, Ray A, Brenzel L, Boonstoppel L, Mogasale V. Cost of conducting Measles-Rubella vaccination campaign in India. Hum Vaccin Immunother 2021; 18:1-8. [PMID: 34411494 PMCID: PMC8920128 DOI: 10.1080/21645515.2021.1961471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A Measles-Rubella (MR) vaccination campaign was launched in India in a phased manner in February 2017 to cover children aged 9 months to 15 years. As evidence on campaign vaccine delivery costs is limited, the delivery cost for MR campaign from a government provider perspective was estimated in four Indian states, namely, Assam, Gujarat, Himachal Pradesh, and Uttar Pradesh. Costs were calculated in top-down and bottom-up approaches using data collected from 84 sites at different administrative levels and immunization partners in the study states from August 2019 to March 2020. All costs were presented in 2019 US$ and Indian Rupee (INR). The financial cost per dose of the MR campaign including all partner support ranged from US$0.16 (INR 10.95) in Uttar Pradesh to US$0.34 (INR 24.13) in Gujarat. In Uttar Pradesh, the full economic cost per dose was US$0.87 (INR 61.39). The key financial cost drivers were incentives related to service delivery and supervision, the printing of reporting formats for record-keeping, social mobilization, and advocacy. The financial delivery cost per dose estimated was higher than the government pre-fixed budget per child for the MR campaign, probably indicating an insufficient budget. However, the study found underutilization of MR budget in two states and use of other sources of funding for the campaign indicating the need for proper utilization of the campaign budgets by the states. Unit cost information generated from this study will be useful for planning, cost projections, and economic analysis of future vaccination campaigns in India.
Collapse
Affiliation(s)
- Susmita Chatterjee
- Department of Research, George Institute for Global Health, New Delhi, India.,Department of Medicine, University of New South Wales, Sydney, Australia.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Dayoung Song
- Department of Policy and Economic Research, International Vaccine Institute, Seoul, Republic of Korea
| | - Palash Das
- Department of Research, George Institute for Global Health, New Delhi, India
| | - Pradeep Haldar
- Immunization Division, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Arindam Ray
- Bill & Melinda Gates Foundation, New Delhi, India
| | | | | | - Vittal Mogasale
- Department of Policy and Economic Research, International Vaccine Institute, Seoul, Republic of Korea
| |
Collapse
|
6
|
Ozawa S, Yemeke TT, Mitgang E, Wedlock PT, Higgins C, Chen HH, Pallas SW, Abimbola T, Wallace A, Bartsch SM, Lee BY. Systematic review of the costs for vaccinators to reach vaccination sites: Incremental costs of reaching hard-to-reach populations. Vaccine 2021; 39:4598-4610. [PMID: 34238610 PMCID: PMC10680154 DOI: 10.1016/j.vaccine.2021.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/07/2021] [Accepted: 05/06/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Economic evidence on how much it may cost for vaccinators to reach populations is important to plan vaccination programs. Moreover, knowing the incremental costs to reach populations that have traditionally been undervaccinated, especially those hard-to-reach who are facing supply-side barriers to vaccination, is essential to expanding immunization coverage to these populations. METHODS We conducted a systematic review to identify estimates of costs associated with getting vaccinators to all vaccination sites. We searched PubMed and the Immunization Delivery Cost Catalogue (IDCC) in 2019 for the following costs to vaccinators: (1) training costs; (2) labor costs, per diems, and incentives; (3) identification of vaccine beneficiary location; and (4) travel costs. We assessed if any of these costs were specific to populations that are hard-to-reach for vaccination, based on a framework for examining supply-side barriers to vaccination. RESULTS We found 19 studies describing average vaccinator training costs at $0.67/person vaccinated or targeted (SD $0.94) and $0.10/dose delivered (SD $0.07). The average cost for vaccinator labor and incentive costs across 29 studies was $2.15/dose (SD $2.08). We identified 13 studies describing intervention costs for a vaccinator to know the location of a beneficiary, with an average cost of $19.69/person (SD $26.65), and six studies describing vaccinator travel costs, with an average cost of $0.07/dose (SD $0.03). Only eight of these studies described hard-to-reach populations for vaccination; two studies examined incremental costs per dose to reach hard-to-reach populations, which were 1.3-2 times higher than the regular costs. The incremental cost to train vaccinators was $0.02/dose, and incremental labor costs for targeting hard-to-reach populations were $0.16-$1.17/dose. CONCLUSION Additional comparative costing studies are needed to understand the potential differential costs for vaccinators reaching the vaccination sites that serve hard-to-reach populations. This will help immunization program planners and decision-makers better allocate resources to extend vaccination programs.
Collapse
Affiliation(s)
- Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA; Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - Tatenda T Yemeke
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Elizabeth Mitgang
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Patrick T Wedlock
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Colleen Higgins
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Hui-Han Chen
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Sarah W Pallas
- Global Immunization Division, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Taiwo Abimbola
- Global Immunization Division, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Aaron Wallace
- Global Immunization Division, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Sarah M Bartsch
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Bruce Y Lee
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| |
Collapse
|
7
|
Sim SY, Watts E, Constenla D, Huang S, Brenzel L, Patenaude BN. Costs of Immunization Programs for 10 Vaccines in 94 Low- and Middle-Income Countries From 2011 to 2030. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:70-77. [PMID: 33431156 PMCID: PMC7813215 DOI: 10.1016/j.jval.2020.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Understanding the level of investment needed for the 2021-2030 decade is important as the global community faces the next strategic period for vaccines and immunization programs. To assist with this goal, we estimated the aggregate costs of immunization programs for ten vaccines in 94 low- and middle-income countries from 2011 to 2030. METHOD We calculated vaccine, immunization delivery and stockpile costs for 94 low- and middle-income countries leveraging the latest available data sources. We conducted scenario analyses to vary assumptions about the relationship between delivery cost and coverage as well as vaccine prices for fully self-financing countries. RESULTS The total aggregate cost of immunization programs in 94 countries for 10 vaccines from 2011 to 2030 is $70.8 billion (confidence interval: $56.6-$93.3) under the base case scenario and $84.1 billion ($72.8-$102.7) under an incremental delivery cost scenario, with an increasing trend over two decades. The relative proportion of vaccine and delivery costs for pneumococcal conjugate, human papillomavirus, and rotavirus vaccines increase as more countries introduce these vaccines. Nine countries in accelerated transition phase bear the highest burden of the costs in the next decade, and uncertainty with vaccine prices for the 17 fully self-financing countries could lead to total costs that are 1.3-13.1 times higher than the base case scenario. CONCLUSION Resource mobilization efforts at the global and country levels will be needed to reach the level of investment needed for the coming decade. Global-level initiatives and targeted strategies for transitioning countries will help ensure the sustainability of immunization programs.
Collapse
Affiliation(s)
- So Yoon Sim
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Elizabeth Watts
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dagna Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; GlaxoSmithKline Plc., Panama City, Panama
| | - Shuoning Huang
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Bryan N Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
8
|
Llau AF, Williams ML, Tejada CE. National vaccine coverage trends and funding in Latin America and the Caribbean. Vaccine 2020; 39:317-323. [PMID: 33288342 DOI: 10.1016/j.vaccine.2020.11.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND From 2006 to 2011 nearly 174,000 deaths were prevented in Latin America and the Caribbean through vaccination of children under five, which is widely attributed to the Expanded Program on Immunization (EPI). Despite near global adoption of EPI recommendations, vaccination coverage shows substantial variation across world regions. Causes for low immunizations within regions are multifaceted and include vaccination program costs. To date, publications regarding vaccine coverage across Latin America and the Caribbean are not readily available. This study aimed to: (1) compare vaccine coverage trends across nations within the region; and (2) assess whether national immunization program expenditures are correlated with vaccine coverage. METHODS Coverage for nine vaccines were collected by nation using publicly available data from WHO. National immunization program expenditures for each country were collected from the World Bank Index. The proportion of countries achieving 90% coverage in the years 2013 and 2017 for each vaccine were compared. Pearson correlation coefficients were calculated to measure the relationship between financing variables and DTP3 coverage for 2017. RESULTS In 2017, fewer Latin American and Caribbean nations were able to achieve 90% vaccine coverage for five vaccines compared to 2013. Mostly weak to moderate positive relationships were found between national immunization program expenditures and DTP3 coverage for 2017. Excluding Haiti, a weak negative relationship was found between total government expenditure on vaccines per infant and DTP3 coverage for 2017. Countries across Latin America and the Caribbean were largely self-reliant in funding vaccine expenditures. CONCLUSIONS Fewer countries across Latin America and the Caribbean are currently achieving optimum national vaccine coverage and weak to moderate relationships between routine immunization and vaccine expenditures and coverage were observed. Additional factors contributing to national vaccine coverage should be concomitantly examined to implement strategies which optimize delivery of childhood immunizations.
Collapse
Affiliation(s)
- Anthoni F Llau
- Florida International University, Robert Stempel College of Public Health and Social Work, Global Health Consortium, United States.
| | - Mark L Williams
- Fay W. Boozman College of Public Health at the University of Arkansas for Medical Sciences (UAMS), United States
| | - Carlos Espinal Tejada
- Florida International University, Robert Stempel College of Public Health and Social Work, Global Health Consortium, United States
| |
Collapse
|
9
|
Sibeudu FT, Onwujekwe OE, Okoronkwo IL. Cost analysis of supplemental immunization activities to deliver measles immunization to children in Anambra state, south-east Nigeria. Vaccine 2020; 38:5947-5954. [DOI: 10.1016/j.vaccine.2020.06.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 10/23/2022]
|
10
|
Sim SY, Watts E, Constenla D, Brenzel L, Patenaude BN. Return On Investment From Immunization Against 10 Pathogens In 94 Low- And Middle-Income Countries, 2011–30. Health Aff (Millwood) 2020; 39:1343-1353. [DOI: 10.1377/hlthaff.2020.00103] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- So Yoon Sim
- So Yoon Sim is a technical officer in the Department of Immunization, Vaccines, and Biologicals at the World Health Organization, in Geneva, Switzerland. She was a health economist and research associate in the Department of International Health, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland, when this work was performed. Sim and Elizabeth Watts share credit as co–first authors
| | - Elizabeth Watts
- Elizabeth Watts is a health economist and research associate in the Department of International Health and in the International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health. Watts and So Yoon Sim share credit as co–first authors
| | - Dagna Constenla
- Dagna Constenla is the director of Epidemiology and Health Outcomes at GSK Vaccines, Latin America and the Caribbean, in Panama City, Panama. She was an associate scientist in the Department of International Health, Johns Hopkins Bloomberg School of Public Health, when this work was performed
| | - Logan Brenzel
- Logan Brenzel is a senior program officer for economics and finance, Vaccine Delivery/Global Development, Bill & Melinda Gates Foundation, in Washington, D.C
| | - Bryan N. Patenaude
- Bryan N. Patenaude is an assistant professor in the Department of International Health, Johns Hopkins Bloomberg School of Public Health
| |
Collapse
|
11
|
Financial cost analysis of a strategy to improve the quality of administrative vaccination data in Uganda. Vaccine 2020; 38:1105-1113. [PMID: 31767466 DOI: 10.1016/j.vaccine.2019.11.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/08/2019] [Accepted: 11/12/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND High-quality vaccination data are critical to planning, implementation and evaluation of immunization programs. However, sub-optimal administrative vaccination data quality in low- and middle-income countries persist for heterogeneous reasons, though most relate to organizational factors and human behavior. The nationwide Data Improvement Team (DIT) strategy in Uganda aimed to strengthen human resource capacity to generate quality administrative vaccination data at the health facility. METHODS A financial cost analysis of the Uganda DIT strategy (2014-2016) was conducted from the program funder perspective. Activity-based micro-costing from funder financial and program monitoring records was used to estimate total and unit costs by program area (in 2016 US dollars). Hypothetical scenarios were developed to illustrate potential approaches to reducing costs. RESULTS Over 25 months the DIT strategy was implemented in all 116 operational districts and 3443 (89%) health facilities in Uganda at a total financial cost of US $575 275. Training and deployment of DITs accounted for the highest proportion of expenditure across program areas (69%). Transport, per diems, lodging, and honoraria for DIT members and national supervisors were the main cost drivers of the strategy. Deployment of 557 DIT members cost US $839 per DIT member, US $4 030 per district, and US $136 per health facility. The estimated opportunity cost of government staff time wasn't a major cost driver (2.5%) of total cost. CONCLUSION The results provide the first estimates of the magnitude and drivers of cost to implement a national workforce capacity building strategy to improve administrative vaccination data quality in a low- or middle-income country. Financial costs are a critical input to combine with future outcome data to describe the cost of strategies relative to performance outcomes. The operational costs of the strategy were modest (0.5-1.6%) relative to the estimated operational costs of Uganda's national immunization program.
Collapse
|
12
|
Portnoy A, Campos NG, Sy S, Burger EA, Cohen J, Regan C, Kim JJ. Impact and Cost-Effectiveness of Human Papillomavirus Vaccination Campaigns. Cancer Epidemiol Biomarkers Prev 2019; 29:22-30. [DOI: 10.1158/1055-9965.epi-19-0767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/13/2019] [Accepted: 10/23/2019] [Indexed: 11/16/2022] Open
|
13
|
Lo NC, Gupta R, Stanaway JD, Garrett DO, Bogoch II, Luby SP, Andrews JR. Comparison of Strategies and Incidence Thresholds for Vi Conjugate Vaccines Against Typhoid Fever: A Cost-effectiveness Modeling Study. J Infect Dis 2019; 218:S232-S242. [PMID: 29444257 PMCID: PMC6226717 DOI: 10.1093/infdis/jix598] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Typhoid fever remains a major public health problem globally. While new Vi conjugate vaccines hold promise for averting disease, the optimal programmatic delivery remains unclear. We aimed to identify the strategies and associated epidemiologic conditions under which Vi conjugate vaccines would be cost-effective. Methods We developed a dynamic, age-structured transmission and cost-effectiveness model that simulated multiple vaccination strategies with a typhoid Vi conjugate vaccine from a societal perspective. We simulated 10-year vaccination programs with (1) routine immunization of infants (aged <1 year) through the Expanded Program on Immunization (EPI) and (2) routine immunization of infants through the EPI plus a 1-time catch-up campaign in school-aged children (aged 5–14 years). In the base case analysis, we assumed a 0.5% case-fatality rate for all cases of clinically symptomatic typhoid fever and defined strategies as highly cost-effective by using the definition of a low-income country (defined as a country with a gross domestic product of $1045 per capita). We defined incidence as the true number of clinically symptomatic people in the population per year. Results Vi conjugate typhoid vaccines were highly cost-effective when administered by routine immunization activities through the EPI in settings with an annual incidence of >50 cases/100000 (95% uncertainty interval, 40–75 cases) and when administered through the EPI plus a catch-up campaign in settings with an annual incidence of >130 cases/100000 (95% uncertainty interval, 50–395 cases). The incidence threshold was sensitive to the typhoid-related case-fatality rate, carrier contribution to transmission, vaccine characteristics, and country-specific economic threshold for cost-effectiveness. Conclusions Typhoid Vi conjugate vaccines would be highly cost-effective in low-income countries in settings of moderate typhoid incidence (50 cases/100000 annually). These results were sensitive to case-fatality rates, underscoring the need to consider factors contributing to typhoid mortality (eg, healthcare access and antimicrobial resistance) in the global vaccination strategy.
Collapse
Affiliation(s)
- Nathan C Lo
- Division of Infectious Diseases and Geographic Medicine, California.,Division of Epidemiology, Stanford University School of Medicine, California
| | - Ribhav Gupta
- Division of Infectious Diseases and Geographic Medicine, California
| | - Jeffrey D Stanaway
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Washington, D. C.,Division of Internal Medicine, Toronto General Hospital, University Health Network, Toronto, Canada.,Division of Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, California
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, California
| |
Collapse
|
14
|
Optimization of frequency and targeting of measles supplemental immunization activities in Nigeria: A cost-effectiveness analysis. Vaccine 2019; 37:6039-6047. [PMID: 31471147 DOI: 10.1016/j.vaccine.2019.08.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Measles causes significant childhood morbidity in Nigeria. Routine immunization (RI) coverage is around 40% country-wide, with very high levels of spatial heterogeneity (3-86%), with supplemental immunization activities (SIAs) at 2-year or 3-year intervals. We investigated cost savings and burden reduction that could be achieved by adjusting the inter-campaign interval by region. METHODS We modeled 81 scenarios; permuting SIA calendars of every one, two, or three years in each of four regions of Nigeria (North-west, North-central, North-east, and South). We used an agent-based disease transmission model to estimate the number of measles cases and ingredients-based cost models to estimate RI and SIA costs for each scenario over a 10 year period. RESULTS Decreasing SIAs to every three years in the North-central and South (regions of above national-average RI coverage) while increasing to every year in either the North-east or North-west (regions of below national-average RI coverage) would avert measles cases (0.4 or 1.4 million, respectively), and save vaccination costs (save $19.4 or $5.4 million, respectively), compared to a base-case of national SIAs every two years. Decreasing SIA frequency to every three years in the South while increasing to every year in the just the North-west, or in all Northern regions would prevent more cases (2.1 or 5.0 million, respectively), but would increase vaccination costs (add $3.5 million or $34.6 million, respectively), for $1.65 or $6.99 per case averted, respectively. CONCLUSIONS Our modeling shows how increasing SIA frequency in Northern regions, where RI is low and birth rates are high, while decreasing frequency in the South of Nigeria would reduce the number of measles cases with relatively little or no increase in vaccination costs. A national vaccination strategy that incorporates regional SIA targeting in contexts with a high level of sub-national variation would lead to improved health outcomes and/or lower costs.
Collapse
|
15
|
Bilcke J, Antillón M, Pieters Z, Kuylen E, Abboud L, Neuzil KM, Pollard AJ, Paltiel AD, Pitzer VE. Cost-effectiveness of routine and campaign use of typhoid Vi-conjugate vaccine in Gavi-eligible countries: a modelling study. THE LANCET. INFECTIOUS DISEASES 2019; 19:728-739. [PMID: 31130329 PMCID: PMC6595249 DOI: 10.1016/s1473-3099(18)30804-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/10/2018] [Accepted: 12/14/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Typhoid fever is a major cause of morbidity and mortality in low-income and middle-income countries. In 2017, WHO recommended the programmatic use of typhoid Vi-conjugate vaccine (TCV) in endemic settings, and Gavi, The Vaccine Alliance, has pledged support for vaccine introduction in these countries. Country-level health economic evaluations are now needed to inform decision-making. METHODS In this modelling study, we compared four strategies: no vaccination, routine immunisation at 9 months, and routine immunisation at 9 months with catch-up campaigns to either age 5 years or 15 years. For each of the 54 countries eligible for Gavi support, output from an age-structured transmission-dynamic model was combined with country-specific treatment and vaccine-related costs, treatment outcomes, and disability weights to estimate the reduction in typhoid burden, identify the strategy that maximised average net benefit (ie, the optimal strategy) across a range of country-specific willingness-to-pay (WTP) values, estimate and investigate the uncertainties surrounding our findings, and identify the epidemiological conditions under which vaccination is optimal. FINDINGS The optimal strategy was either no vaccination or TCV immunisation including a catch-up campaign. Routine vaccination with a catch-up campaign to 15 years of age was optimal in 38 countries, assuming a WTP value of at least US$200 per disability-adjusted life-year (DALY) averted, or assuming a WTP value of at least 25% of each country's gross domestic product (GDP) per capita per DALY averted, at a vaccine price of $1·50 per dose (but excluding Gavi's contribution according to each country's transition phase). This vaccination strategy was also optimal in 48 countries assuming a WTP of at least $500 per DALY averted, in 51 with assumed WTP values of at least $1000, in 47 countries assuming a WTP value of at least 50% of GDP per capita per DALY averted, and in 49 assuming a minimum of 100%. Vaccination was likely to be cost-effective in countries with 300 or more typhoid cases per 100 000 person-years. Uncertainty about the probability of hospital admission (and typhoid incidence and mortality) had the greatest influence on the optimal strategy. INTERPRETATION Countries should establish their own WTP threshold and consider routine TCV introduction, including a catch-up campaign when vaccination is optimal on the basis of this threshold. Obtaining improved estimates of the probability of hospital admission would be valuable whenever the optimal strategy is uncertain. FUNDING Bill & Melinda Gates Foundation, Research Foundation-Flanders, and the Belgian-American Education Foundation.
Collapse
Affiliation(s)
- Joke Bilcke
- Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
| | - Marina Antillón
- Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Zoë Pieters
- Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Center for Statistics, I-Biostat, Hasselt University, Diepenbeek, Belgium
| | - Elise Kuylen
- Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Linda Abboud
- Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK
| | - A David Paltiel
- Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA.
| |
Collapse
|
16
|
Muhamad NA, Buang SN, Jaafar S, Jais R, Tan PS, Mustapha N, Lodz NA, Aris T, Sulaiman LH, Murad S. Achieving high uptake of human papillomavirus vaccination in Malaysia through school-based vaccination programme. BMC Public Health 2018; 18:1402. [PMID: 30577816 PMCID: PMC6303856 DOI: 10.1186/s12889-018-6316-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/11/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In 2006, 4 years of planning was started by the Ministry of Health, Malaysia (MOH), to implement the HPV (human papillomavirus) vaccination programme. An inter-agency and multi-sectoral collaborations were developed for Malaysia's HPV school-based immunisation programme. It was approved for nationwide school base implementation for 13-year-old girls or first year secondary students in 2010. This paper examines how the various strategies used in the implementation over the last 7 years (2010-2016) that unique to Malaysia were successful in achieving optimal coverage of the target population. METHODS Free vaccination was offered to school girls in secondary school (year seven) in Malaysia, which is usually at the age of 13 in the index year. All recipients of the HPV vaccine were identified through school enrolments obtained from education departments from each district in Malaysia. A total of 242,638 girls aged between 12 to 13 years studying in year seven were approached during the launch of the program in 2010. Approximately 230,000 girls in secondary schools were offered HPV vaccine per year by 646 school health teams throughout the country from 2010 to 2016. RESULTS Parental consent for their daughters to receive HPV vaccination at school was very high at 96-98% per year of the programme. Of those who provided consent, over 99% received the first dose each year and 98-99% completed the course per year. Estimated population coverage for the full vaccine course, considering also those not in school, is estimated at 83 to 91% per year. Rates of adverse events reports following HPV vaccination were low at around 2 per 100,000 and the majority was injection site reactions. CONCLUSION A multisectoral and integrated collaborative structure and process ensured that the Malaysia school-based HPV immunisation programme was successful and sustained through the programme design, planning, implementation and monitoring and evaluation. This is a critical factor contributing to the success and sustainability of the school-based HPV immunisation programme with very high coverage.
Collapse
Affiliation(s)
- Nor Asiah Muhamad
- Institute for Public Health, Ministry of Health, Kuala Lumpur, Malaysia. .,Disease Control Division, Ministry of Health, Kuala Lumpur, Malaysia.
| | | | - Safurah Jaafar
- Family Health Development Division, Ministry of Health, Kuala Lumpur, Malaysia.,Department of Community Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Rohani Jais
- Disease Control Division, Ministry of Health, Kuala Lumpur, Malaysia
| | - Phaik Sim Tan
- Family Health Development Division, Ministry of Health, Kuala Lumpur, Malaysia
| | - Normi Mustapha
- Faculty of Science and Technology, Open University Malaysia, Kuala Lumpur, Malaysia
| | - Noor Aliza Lodz
- Institute for Public Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Tahir Aris
- Institute for Public Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Lokman Hakim Sulaiman
- Department of Community Medicine, International Medical University, Kuala Lumpur, Malaysia.,Office of Deputy Director General of Health (Public Health), Ministry of Health, Putrajaya, Malaysia
| | - Shahnaz Murad
- Office of Deputy Director General of Health (Research and Technical Support), Ministry of Health, Putrajaya, Malaysia
| |
Collapse
|
17
|
Doshi RH, Eckhoff P, Cheng A, Hoff NA, Mukadi P, Shidi C, Gerber S, Wemakoy EO, Muyembe-Tafum JJ, Kominski GF, Rimoin AW. Assessing the cost-effectiveness of different measles vaccination strategies for children in the Democratic Republic of Congo. Vaccine 2017; 35:6187-6194. [PMID: 28966000 DOI: 10.1016/j.vaccine.2017.09.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/07/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION One of the goals of the Global Measles and Rubella Strategic Plan is the reduction in global measles mortality, with high measles vaccination coverage as one of its core components. While measles mortality has been reduced more than 79%, the disease remains a major cause of childhood vaccine preventable disease burden globally. Measles immunization requires a two-dose schedule and only countries with strong, stable immunization programs can rely on routine services to deliver the second dose. In the Democratic Republic of Congo (DRC), weak health infrastructure and lack of provision of the second dose of measles vaccine necessitates the use of supplementary immunization activities (SIAs) to administer the second dose. METHODS We modeled three vaccination strategies using an age-structured SIR (Susceptible-Infectious-Recovered) model to simulate natural measles dynamics along with the effect of immunization. We compared the cost-effectiveness of two different strategies for the second dose of Measles Containing Vaccine (MCV) to one dose of MCV through routine immunization services over a 15-year time period for a hypothetical birth cohort of 3 million children. RESULTS Compared to strategy 1 (MCV1 only), strategy 2 (MCV2 by SIA) would prevent a total of 5,808,750 measles cases, 156,836 measles-related deaths and save U.S. $199 million. Compared to strategy 1, strategy 3 (MCV2 by RI) would prevent a total of 13,232,250 measles cases, 166,475 measles-related deaths and save U.S. $408 million. DISCUSSION Vaccination recommendations should be tailored to each country, offering a framework where countries can adapt to local epidemiological and economical circumstances in the context of other health priorities. Our results reflect the synergistic effect of two doses of MCV and demonstrate that the most cost-effective approach to measles vaccination in DRC is to incorporate the second dose of MCV in the RI schedule provided that high enough coverage can be achieved.
Collapse
Affiliation(s)
- Reena H Doshi
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA 90095, USA.
| | | | - Alvan Cheng
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA 90095, USA
| | - Nicole A Hoff
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA 90095, USA.
| | - Patrick Mukadi
- Department of Microbiology, Kinshasa School of Medicine, B.P. 127 Kinshasa, Lemba, Kinshasa, Democratic Republic of the Congo.
| | - Calixte Shidi
- Expanded Programme on Immunization, Ave de la Justice, Kinshasa, Democratic Republic of the Congo.
| | - Sue Gerber
- Polio Program, Bill and Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, WA 98109, USA.
| | - Emile Okitolonda Wemakoy
- Kinshasa School of Public Health, B.P. 127 Kinshasa, Lemba, Kinshasa, Democratic Republic of Congo.
| | | | - Gerald F Kominski
- Department of Health Policy and Management, UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Anne W Rimoin
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA 90095, USA.
| |
Collapse
|
18
|
Closser S, Rosenthal A, Justice J, Maes K, Sultan M, Banerji S, Amaha HB, Gopinath R, Omidian P, Nyirazinyoye L. Per Diems in Polio Eradication: Perspectives From Community Health Workers and Officials. Am J Public Health 2017; 107:1470-1476. [PMID: 28727538 DOI: 10.2105/ajph.2017.303886] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Nearly all global health initiatives give per diems to community health workers (CHWs) in poor countries for short-term work on disease-specific programs. We interviewed CHWs, supervisors, and high-level officials (n = 95) in 6 study sites across sub-Saharan Africa and South Asia in early 2012 about the per diems given to them by the Global Polio Eradication Initiative. These per diems for CHWs ranged from $1.50 to $2.40 per day. International officials defended per diems for CHWs with an array of arguments, primarily that they were necessary to defray the expenses that workers incurred during campaigns. But high-level ministry of health officials in many countries were concerned that even small per diems were unsustainable. By contrast, CHWs saw per diems as a wage; the very small size of this wage led many to describe per diems as unjust. Per diem polio work existed in the larger context of limited and mostly exploitative options for female labor. Taking the perspectives of CHWs seriously would shift the international conversation about per diems toward questions of labor rights and justice in global health pay structures.
Collapse
Affiliation(s)
- Svea Closser
- Svea Closser, Marium Sultan, and Sarah Banerji are with the Department of Sociology/Anthropology, Middlebury College, Middlebury, VT. Anat Rosenthal is with the Department of Health Systems Management, Ben-Gurion University of the Negev, Beer Sheva, Israel. Judith Justice is with the Philip R. Lee Institute for Health Policy Studies, University of California, Berkeley. Kenneth Maes is with the Department of Anthropology, Oregon State University, Corvallis. Hailom Banteyerga Amaha is with Addis Ababa University, Addis Ababa, Ethiopia. Ranjani Gopinath is an independent consultant based in Hyderabad, India. Patricia Omidian is an independent consultant based in Corvallis, OR. Laetitia Nyrazinyoye is with the School of Public Health, Kigali, Rwanda
| | - Anat Rosenthal
- Svea Closser, Marium Sultan, and Sarah Banerji are with the Department of Sociology/Anthropology, Middlebury College, Middlebury, VT. Anat Rosenthal is with the Department of Health Systems Management, Ben-Gurion University of the Negev, Beer Sheva, Israel. Judith Justice is with the Philip R. Lee Institute for Health Policy Studies, University of California, Berkeley. Kenneth Maes is with the Department of Anthropology, Oregon State University, Corvallis. Hailom Banteyerga Amaha is with Addis Ababa University, Addis Ababa, Ethiopia. Ranjani Gopinath is an independent consultant based in Hyderabad, India. Patricia Omidian is an independent consultant based in Corvallis, OR. Laetitia Nyrazinyoye is with the School of Public Health, Kigali, Rwanda
| | - Judith Justice
- Svea Closser, Marium Sultan, and Sarah Banerji are with the Department of Sociology/Anthropology, Middlebury College, Middlebury, VT. Anat Rosenthal is with the Department of Health Systems Management, Ben-Gurion University of the Negev, Beer Sheva, Israel. Judith Justice is with the Philip R. Lee Institute for Health Policy Studies, University of California, Berkeley. Kenneth Maes is with the Department of Anthropology, Oregon State University, Corvallis. Hailom Banteyerga Amaha is with Addis Ababa University, Addis Ababa, Ethiopia. Ranjani Gopinath is an independent consultant based in Hyderabad, India. Patricia Omidian is an independent consultant based in Corvallis, OR. Laetitia Nyrazinyoye is with the School of Public Health, Kigali, Rwanda
| | - Kenneth Maes
- Svea Closser, Marium Sultan, and Sarah Banerji are with the Department of Sociology/Anthropology, Middlebury College, Middlebury, VT. Anat Rosenthal is with the Department of Health Systems Management, Ben-Gurion University of the Negev, Beer Sheva, Israel. Judith Justice is with the Philip R. Lee Institute for Health Policy Studies, University of California, Berkeley. Kenneth Maes is with the Department of Anthropology, Oregon State University, Corvallis. Hailom Banteyerga Amaha is with Addis Ababa University, Addis Ababa, Ethiopia. Ranjani Gopinath is an independent consultant based in Hyderabad, India. Patricia Omidian is an independent consultant based in Corvallis, OR. Laetitia Nyrazinyoye is with the School of Public Health, Kigali, Rwanda
| | - Marium Sultan
- Svea Closser, Marium Sultan, and Sarah Banerji are with the Department of Sociology/Anthropology, Middlebury College, Middlebury, VT. Anat Rosenthal is with the Department of Health Systems Management, Ben-Gurion University of the Negev, Beer Sheva, Israel. Judith Justice is with the Philip R. Lee Institute for Health Policy Studies, University of California, Berkeley. Kenneth Maes is with the Department of Anthropology, Oregon State University, Corvallis. Hailom Banteyerga Amaha is with Addis Ababa University, Addis Ababa, Ethiopia. Ranjani Gopinath is an independent consultant based in Hyderabad, India. Patricia Omidian is an independent consultant based in Corvallis, OR. Laetitia Nyrazinyoye is with the School of Public Health, Kigali, Rwanda
| | - Sarah Banerji
- Svea Closser, Marium Sultan, and Sarah Banerji are with the Department of Sociology/Anthropology, Middlebury College, Middlebury, VT. Anat Rosenthal is with the Department of Health Systems Management, Ben-Gurion University of the Negev, Beer Sheva, Israel. Judith Justice is with the Philip R. Lee Institute for Health Policy Studies, University of California, Berkeley. Kenneth Maes is with the Department of Anthropology, Oregon State University, Corvallis. Hailom Banteyerga Amaha is with Addis Ababa University, Addis Ababa, Ethiopia. Ranjani Gopinath is an independent consultant based in Hyderabad, India. Patricia Omidian is an independent consultant based in Corvallis, OR. Laetitia Nyrazinyoye is with the School of Public Health, Kigali, Rwanda
| | - Hailom Banteyerga Amaha
- Svea Closser, Marium Sultan, and Sarah Banerji are with the Department of Sociology/Anthropology, Middlebury College, Middlebury, VT. Anat Rosenthal is with the Department of Health Systems Management, Ben-Gurion University of the Negev, Beer Sheva, Israel. Judith Justice is with the Philip R. Lee Institute for Health Policy Studies, University of California, Berkeley. Kenneth Maes is with the Department of Anthropology, Oregon State University, Corvallis. Hailom Banteyerga Amaha is with Addis Ababa University, Addis Ababa, Ethiopia. Ranjani Gopinath is an independent consultant based in Hyderabad, India. Patricia Omidian is an independent consultant based in Corvallis, OR. Laetitia Nyrazinyoye is with the School of Public Health, Kigali, Rwanda
| | - Ranjani Gopinath
- Svea Closser, Marium Sultan, and Sarah Banerji are with the Department of Sociology/Anthropology, Middlebury College, Middlebury, VT. Anat Rosenthal is with the Department of Health Systems Management, Ben-Gurion University of the Negev, Beer Sheva, Israel. Judith Justice is with the Philip R. Lee Institute for Health Policy Studies, University of California, Berkeley. Kenneth Maes is with the Department of Anthropology, Oregon State University, Corvallis. Hailom Banteyerga Amaha is with Addis Ababa University, Addis Ababa, Ethiopia. Ranjani Gopinath is an independent consultant based in Hyderabad, India. Patricia Omidian is an independent consultant based in Corvallis, OR. Laetitia Nyrazinyoye is with the School of Public Health, Kigali, Rwanda
| | - Patricia Omidian
- Svea Closser, Marium Sultan, and Sarah Banerji are with the Department of Sociology/Anthropology, Middlebury College, Middlebury, VT. Anat Rosenthal is with the Department of Health Systems Management, Ben-Gurion University of the Negev, Beer Sheva, Israel. Judith Justice is with the Philip R. Lee Institute for Health Policy Studies, University of California, Berkeley. Kenneth Maes is with the Department of Anthropology, Oregon State University, Corvallis. Hailom Banteyerga Amaha is with Addis Ababa University, Addis Ababa, Ethiopia. Ranjani Gopinath is an independent consultant based in Hyderabad, India. Patricia Omidian is an independent consultant based in Corvallis, OR. Laetitia Nyrazinyoye is with the School of Public Health, Kigali, Rwanda
| | - Laetitia Nyirazinyoye
- Svea Closser, Marium Sultan, and Sarah Banerji are with the Department of Sociology/Anthropology, Middlebury College, Middlebury, VT. Anat Rosenthal is with the Department of Health Systems Management, Ben-Gurion University of the Negev, Beer Sheva, Israel. Judith Justice is with the Philip R. Lee Institute for Health Policy Studies, University of California, Berkeley. Kenneth Maes is with the Department of Anthropology, Oregon State University, Corvallis. Hailom Banteyerga Amaha is with Addis Ababa University, Addis Ababa, Ethiopia. Ranjani Gopinath is an independent consultant based in Hyderabad, India. Patricia Omidian is an independent consultant based in Corvallis, OR. Laetitia Nyrazinyoye is with the School of Public Health, Kigali, Rwanda
| |
Collapse
|
19
|
Kaufman J, Ames H, Bosch-Capblanch X, Cartier Y, Cliff J, Glenton C, Lewin S, Muloliwa AM, Oku A, Oyo-Ita A, Rada G, Hill S. The comprehensive 'Communicate to Vaccinate' taxonomy of communication interventions for childhood vaccination in routine and campaign contexts. BMC Public Health 2017; 17:423. [PMID: 28486956 PMCID: PMC5424416 DOI: 10.1186/s12889-017-4320-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 04/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Communication can be used to generate demand for vaccination or address vaccine hesitancy, and is crucial to successful childhood vaccination programmes. Research efforts have primarily focused on communication for routine vaccination. However, vaccination campaigns, particularly in low- or middle-income countries (LMICs), also use communication in diverse ways. Without a comprehensive framework integrating communication interventions from routine and campaign contexts, it is not possible to conceptualise the full range of possible vaccination communication interventions. Therefore, vaccine programme managers may be unaware of potential communication options and researchers may not focus on building evidence for interventions used in practice. In this paper, we broaden the scope of our existing taxonomy of communication interventions for routine vaccination to include communication used in campaigns, and integrate these into a comprehensive taxonomy of vaccination communication interventions. METHODS Building on our taxonomy of communication for routine vaccination, we identified communication interventions used in vaccination campaigns through a targeted literature search; observation of vaccination activities in Cameroon, Mozambique and Nigeria; and stakeholder consultations. We added these interventions to descriptions of routine vaccination communication and categorised the interventions according to their intended purposes, building from an earlier taxonomy of communication related to routine vaccination. RESULTS The comprehensive taxonomy groups communication used in campaigns and routine childhood vaccination into seven purpose categories: 'Inform or Educate'; 'Remind or Recall'; 'Enhance Community Ownership'; 'Teach Skills'; 'Provide Support'; 'Facilitate Decision Making' and 'Enable Communication'. Consultations with LMIC stakeholders and experts informed the taxonomy's definitions and structure and established its potential uses. CONCLUSIONS This taxonomy provides a standardised way to think and speak about vaccination communication. It is categorised by purpose to help conceptualise communication interventions as potential solutions to address needs or problems. It can be utilised by programme planners, implementers, researchers and funders to see the range of communication interventions used in practice, facilitate evidence synthesis and identify evidence gaps.
Collapse
Affiliation(s)
- Jessica Kaufman
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Heather Ames
- Norwegian Institute of Public Health, Oslo, Norway
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Yuri Cartier
- International Union for Health Promotion and Education, Saint-Maurice Cedex, France
| | - Julie Cliff
- Eduardo Mondlane University, Maputo, Mozambique
| | | | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- South African Medical Research Council, Cape Town, South Africa
| | | | | | | | - Gabriel Rada
- Pontifical Catholic University of Chile, Santiago, Chile
| | - Sophie Hill
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| |
Collapse
|
20
|
Ozawa S, Grewal S, Portnoy A, Sinha A, Arilotta R, Stack ML, Brenzel L. Funding gap for immunization across 94 low- and middle-income countries. Vaccine 2016; 34:6408-6416. [PMID: 28029541 PMCID: PMC5142419 DOI: 10.1016/j.vaccine.2016.09.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 09/12/2016] [Accepted: 09/15/2016] [Indexed: 11/09/2022]
Abstract
Novel vaccine development and production has given rise to a growing number of vaccines that can prevent disease and save lives. In order to realize these health benefits, it is essential to ensure adequate immunization financing to enable equitable access to vaccines for people in all communities. This analysis estimates the full immunization program costs, projected available financing, and resulting funding gap for 94 low- and middle-income countries over five years (2016-2020). Vaccine program financing by country governments, Gavi, and other development partners was forecasted for vaccine, supply chain, and service delivery, based on an analysis of comprehensive multi-year plans together with a series of scenario and sensitivity analyses. Findings indicate that delivery of full vaccination programs across 94 countries would result in a total funding gap of $7.6 billion (95% uncertainty range: $4.6-$11.8 billion) over 2016-2020, with the bulk (98%) of the resources required for routine immunization programs. More than half (65%) of the resources to meet this funding gap are required for service delivery at $5.0 billion ($2.7-$8.4 billion) with an additional $1.1 billion ($0.9-$2.7 billion) needed for vaccines and $1.5 billion ($1.1-$2.0 billion) for supply chain. When viewed as a percentage of total projected costs, the funding gap represents 66% of projected supply chain costs, 30% of service delivery costs, and 9% of vaccine costs. On average, this funding gap corresponds to 0.2% of general government expenditures and 2.3% of government health expenditures. These results suggest greater need for country and donor resource mobilization and funding allocation for immunizations. Both service delivery and supply chain are important areas for further resource mobilization. Further research on the impact of advances in service delivery technology and reductions in vaccine prices beyond this decade would be important for efficient investment decisions for immunization.
Collapse
Affiliation(s)
- Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA.
| | - Simrun Grewal
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Allison Portnoy
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anushua Sinha
- Department of Preventive Medicine and Community Health, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Richard Arilotta
- Department of Preventive Medicine and Community Health, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | | | - Logan Brenzel
- Bill and Melinda Gates Foundation, Washington, DC, USA
| |
Collapse
|
21
|
Thompson KM, Odahowski CL. The Costs and Valuation of Health Impacts of Measles and Rubella Risk Management Policies. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2016; 36:1357-1382. [PMID: 26249331 DOI: 10.1111/risa.12459] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 05/26/2015] [Indexed: 06/04/2023]
Abstract
National and global health policymakers require good information about the costs and benefits of their investments in measles and rubella immunization programs. Building on our review of the existing measles and rubella health economics literature, we develop inputs for use in regional and global models of the expected future benefits and costs of vaccination, treatment, surveillance, and other global coordination activities. Given diversity in the world and limited data, we characterize the costs for countries according to the 2013 World Bank income levels using 2013 U.S. dollars (2013$US). We estimate that routine immunization and supplemental immunization activities will cost governments and donors over 2013$US 2.3 billion per year for the foreseeable future, with high-income countries accounting for 55% of the costs, to vaccinate global birth cohorts of approximately 134 million surviving infants and to protect the global population of over 7 billion people. We find significantly higher costs and health consequences of measles or rubella disease than with vaccine use, with the expected disability-adjusted life year (DALY) loss for case of disease generally at least 100 times the loss per vaccine dose. To support estimates of the economic benefits of investments in measles and/or rubella elimination or control, we characterize the probabilities of various sequelae of measles and rubella infections and vaccine adverse events, the DALY inputs for health outcomes, and the associated treatment costs. Managing measles and rubella to achieve the existing and future regional measles and rubella goals and the objectives of the Global Vaccine Action Plan will require an ongoing commitment of financial resources that will prevent adverse health outcomes and save the associated treatment costs.
Collapse
Affiliation(s)
- Kimberly M Thompson
- Kid Risk, Inc, Orlando, FL, USA
- University of Central Florida, College of Medicine, Orlando, FL, USA
| | | |
Collapse
|
22
|
Abstract
Dengue is a major public health concern in tropical and subtropical areas of the world. The prospects for dengue prevention have recently improved with the results of efficacy trials of a tetravalent dengue vaccine. Although partially effective, once licensed, its introduction can be a public health priority in heavily affected countries because of the perceived public health importance of dengue. This review explores the most immediate economic considerations of introducing a new dengue vaccine and evaluates the published economic analyses of dengue vaccination. Findings indicate that the current economic evidence base is of limited utility to support country-level decisions on dengue vaccine introduction. There are a handful of published cost-effectiveness studies and no country-specific costing studies to project the full resource requirements of dengue vaccine introduction. Country-level analytical expertise in economic analyses, another gap identified, needs to be strengthened to facilitate evidence-based decision-making on dengue vaccine introduction in endemic countries.
Collapse
Affiliation(s)
- Yesim Tozan
- a College of Global Public Health , New York University , New York , NY , USA
| |
Collapse
|
23
|
Gandhi G. Charting the evolution of approaches employed by the Global Alliance for Vaccines and Immunizations (GAVI) to address inequities in access to immunization: a systematic qualitative review of GAVI policies, strategies and resource allocation mechanisms through an equity lens (1999-2014). BMC Public Health 2015; 15:1198. [PMID: 26621528 PMCID: PMC4665898 DOI: 10.1186/s12889-015-2521-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 11/18/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND GAVI's focus on reducing inequities in access to vaccines, immunization, and GAVI funds, - both between and within countries - has changed over time. This paper charts that evolution. METHODS A systematic qualitative review was conducted by searching PubMed, Google Scholar and direct review of available GAVI Board papers, policies, and program guidelines. Documents were included if they described or evaluated GAVI policies, strategies, or programs and discussed equity of access to vaccines, utilization of immunization services, or GAVI funds in countries currently or previously eligible for GAVI support. Findings were grouped thematically, categorized into time periods covering GAVI's phases of operations, and assessed depending on whether the approaches mediated equity of opportunity or equity of outcomes between or within countries. RESULTS Serches yielded 2816 documents for assessment. After pre-screening and removal of duplicates, 552 documents underwent detailed evaluation and pertinent information was extracted from 188 unique documents. As a global funding mechanism, GAVI responded rationally to a semi-fixed funding constraint by focusing on between-country equity in allocation of resources. GAVI's predominant focus and documented successes have been in addressing between-country inequities in access to vaccines comparing lower income (GAVI-eligible) countries with higher income (ineligible) countries. GAVI has had mixed results at addressing between-country inequities in utilization of immunization services, and has only more recently put greater emphasis and resources towards addressing within-country inequities in utilization to immunization services. Over time, GAVI has progressively added vaccines to its portfolio. This expansion should have addressed inter-country, inter-regional, inter-generational and gender inequities in disease burden, however, evidence is scant with respect to final outcomes. CONCLUSION In its next phase of operations, the Alliance can continue to demonstrate its strength as a highly effective multi-partner enterprise, capable of learning and innovating in a world that has changed much since its inception. By building on its successes, developing more coherent and consistent approaches to address inequities between and within countries and by monitoring progress and outcomes, GAVI is well-positioned to bring the benefits of vaccination to previously unreached and underserved communities towards provision of universal health coverage.
Collapse
Affiliation(s)
- Gian Gandhi
- United Nations Children's Fund, New York, USA.
| |
Collapse
|
24
|
Khan R, Vandelaer J, Yakubu A, Raza AA, Zulu F. Maternal and neonatal tetanus elimination: from protecting women and newborns to protecting all. Int J Womens Health 2015; 7:171-80. [PMID: 25678822 PMCID: PMC4322871 DOI: 10.2147/ijwh.s50539] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
A total of 35 of the 59 countries that had not eliminated maternal and neonatal tetanus (MNT) as a public health problem in 1999 have since achieved the MNT-elimination goal. Neonatal tetanus deaths have decreased globally from 200,000 in 2000 to 49,000 in 2013. This is the result of increased immunization coverage with tetanus toxoid-containing vaccines among pregnant women, improved access to skilled birth attendance during delivery, and targeted campaigns with these vaccines for women of reproductive age in high-risk areas. In the process, inequities have been reduced, private–public partnerships fostered, and innovations triggered. However, lack of funding, poor accessibility to some areas, suboptimal surveillance, and a perceived low priority for the disease are among the main obstacles. To ensure MNT elimination is sustained, countries must build and maintain strong routine programs that reach people with vaccination and with clean deliveries. This should also be an opportunity to shift programs into preventing tetanus among all people. Regular assessments, and where needed appropriate action, are key to prevent increases in MNT incidence over time, especially in areas that are at higher risk. The main objective of the paper is to provide a detailed update on the progress toward MNT elimination between 1999 and 2014. It elaborates on the challenges and opportunities, and discusses how MNT elimination can be sustained and to shift the program to protect wider populations against tetanus.
Collapse
Affiliation(s)
- Rownak Khan
- Health Section, Programme Division, UNICEF, New York, NY, USA
| | - Jos Vandelaer
- Health Section, Programme Division, UNICEF, New York, NY, USA
| | - Ahmadu Yakubu
- Family, Women and Children's Health Cluster, World Health Organization, Geneva, Switzerland
| | - Azhar Abid Raza
- Health Section, Programme Division, UNICEF, New York, NY, USA
| | - Flint Zulu
- Health Section, Programme Division, UNICEF, New York, NY, USA
| |
Collapse
|