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Liu Y, Procter SR, Pearson CAB, Montero AM, Torres-Rueda S, Asfaw E, Uzochukwu B, Drake T, Bergren E, Eggo RM, Ruiz F, Ndembi N, Nonvignon J, Jit M, Vassall A. Assessing the impacts of COVID-19 vaccination programme's timing and speed on health benefits, cost-effectiveness, and relative affordability in 27 African countries. BMC Med 2023; 21:85. [PMID: 36882868 PMCID: PMC9991879 DOI: 10.1186/s12916-023-02784-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 02/13/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The COVID-19 vaccine supply shortage in 2021 constrained roll-out efforts in Africa while populations experienced waves of epidemics. As supply improves, a key question is whether vaccination remains an impactful and cost-effective strategy given changes in the timing of implementation. METHODS We assessed the impact of vaccination programme timing using an epidemiological and economic model. We fitted an age-specific dynamic transmission model to reported COVID-19 deaths in 27 African countries to approximate existing immunity resulting from infection before substantial vaccine roll-out. We then projected health outcomes (from symptomatic cases to overall disability-adjusted life years (DALYs) averted) for different programme start dates (01 January to 01 December 2021, n = 12) and roll-out rates (slow, medium, fast; 275, 826, and 2066 doses/million population-day, respectively) for viral vector and mRNA vaccines by the end of 2022. Roll-out rates used were derived from observed uptake trajectories in this region. Vaccination programmes were assumed to prioritise those above 60 years before other adults. We collected data on vaccine delivery costs, calculated incremental cost-effectiveness ratios (ICERs) compared to no vaccine use, and compared these ICERs to GDP per capita. We additionally calculated a relative affordability measure of vaccination programmes to assess potential nonmarginal budget impacts. RESULTS Vaccination programmes with early start dates yielded the most health benefits and lowest ICERs compared to those with late starts. While producing the most health benefits, fast vaccine roll-out did not always result in the lowest ICERs. The highest marginal effectiveness within vaccination programmes was found among older adults. High country income groups, high proportions of populations over 60 years or non-susceptible at the start of vaccination programmes are associated with low ICERs relative to GDP per capita. Most vaccination programmes with small ICERs relative to GDP per capita were also relatively affordable. CONCLUSION Although ICERs increased significantly as vaccination programmes were delayed, programmes starting late in 2021 may still generate low ICERs and manageable affordability measures. Looking forward, lower vaccine purchasing costs and vaccines with improved efficacies can help increase the economic value of COVID-19 vaccination programmes.
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Affiliation(s)
- Yang Liu
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, UK. .,Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.
| | - Simon R Procter
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.,Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, UK
| | - Carl A B Pearson
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.,Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.,South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, Republic of South Africa
| | - Andrés Madriz Montero
- Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London, UK
| | - Sergio Torres-Rueda
- Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London, UK
| | - Elias Asfaw
- Health Economics Programme, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Benjamin Uzochukwu
- Department of Community Medicine, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria
| | - Tom Drake
- Centre for Global Development, Great Peter House, Abbey Gardens, Great College St, London, UK
| | - Eleanor Bergren
- Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London, UK
| | - Rosalind M Eggo
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.,Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, UK
| | - Francis Ruiz
- Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London, UK
| | - Nicaise Ndembi
- Institute of Human Virology, University of Maryland School of Medicine, 725 W Lombard St, Baltimore, MD, USA.,Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Justice Nonvignon
- Health Economics Programme, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia.,School of Public Health, University of Ghana, Legon, Ghana
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.,Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, UK
| | - Anna Vassall
- Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London, UK
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Turatto F, Sassano M, Goletti M, Severoni S, Grossi A, Parente P. Ensuring Equitable Access to the COVID-19 Vaccine: The Experience of A Local Health Unit in Rome, Italy. Healthcare (Basel) 2022; 10:healthcare10112246. [PMID: 36360587 PMCID: PMC9690205 DOI: 10.3390/healthcare10112246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/22/2022] [Accepted: 11/04/2022] [Indexed: 11/12/2022] Open
Abstract
Growing evidence is emerging on the higher risk of infection and adverse outcomes for the most disadvantaged groups of the population, and COVID-19 vaccination campaigns worldwide are struggling to ensure equitable access to immunization for all. From 21 June 2021 to 15 October 2021, the Local Health Unit ASL Roma 1 adopted a tailored immunization strategy to reach socially vulnerable groups of the population with the primary vaccination course. This strategy was developed with a step-by-step, participatory approach. Through engagement with internal and external stakeholders, target groups were identified, potential barriers analyzed, solutions discussed, and tailored interventions designed. Over nine thousand individuals from among irregular migrants, homeless people and hard-to-reach communities were contacted and vaccinated.
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Affiliation(s)
- Federica Turatto
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Michele Sassano
- Department of Life Science and Public Health, Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Mauro Goletti
- Local Health Authority ASL Roma 1, 00193 Rome, Italy
| | - Santino Severoni
- Health and Migration Programme, World Health Organization, 1211 Geneva, Switzerland
| | - Adriano Grossi
- Local Health Authority ASL Roma 1, 00193 Rome, Italy
- Correspondence:
| | - Paolo Parente
- Local Health Authority ASL Roma 1, 00193 Rome, Italy
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