Estimating the Public Health and Economic Impact of Introducing the 13-Valent Pneumococcal Conjugate Vaccine or 10-Valent Pneumococcal Conjugate Vaccines into State Immunization Programs in India

Chronicling the Journey of Pneumococcal Conjugate Vaccine Introduction in India

BACKGROUND

Globally, pneumonia claims the lives of about 700,000 children under the age of 5 every year. Pneumococcal conjugate vaccine (PCV) was introduced in India phase-wise, beginning in high-burden states, and the rollout was completed nationwide by 2021-representing a major initiative by the Ministry of Health and Family Welfare (MoHFW). Despite the challenges posed by the COVID-19 pandemic, the campaign succeeded in maintaining progress and achieving nationwide coverage. This narrative review highlights the significant decisions, processes, and coordinated efforts of the various stakeholders involved that led to this successful PCV rollout.

METHODOLOGY

A comprehensive desk review of both published and unpublished literature relevant to pneumonia burden and the efficacy and effectiveness of PCVs, along with documentation of PCV introduction and the scale-up was carried out.

RESULTS

The documentation of the PCV journey has been broken down into four sections: pre-introduction, PCV Phase-I introduction, pan-India rapid expansion, and the period post-introduction. Since the nationwide rollout in 2021, PCV coverage in India has steadily increased, reflecting successful immunization efforts. WUENIC, which is an annual WHO, and UNICEF estimates of national immunization coverage also show a positive trend in vaccination coverage (PCV booster coverage = 25% (2021), rising to 83% (2023), aligning with the goals of the WHO and UNICEF's Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD).

CONCLUSIONS

The phased rollout was an ambitious effort by the MoHFW, which was particularly challenging given the overlap with the COVID-19 pandemic. Despite these hurdles, the MoHFW, along with strong collaboration from development partners and stakeholders, successfully navigated the complex rollout. Future studies on the role of PCVs in reducing antibiotic resistance and the economic benefits of PCV introduction could help policymakers sustain funding and prioritize vaccine procurement decisions.

Do current economic evaluations fully capture vaccine value: a review of evidence from India

INTRODUCTION

Traditional economic evaluations typically focus on direct health effects and costs offset to the healthcare system. However, vaccines offer significant indirect benefits beyond direct health effects, such as herd immunity, reduced force of infection, reduction in antimicrobial resistance, and others. Failure to consider these benefits while evaluating vaccines may undervalue vaccines. Therefore, it is argued that the full value of vaccines should be estimated by incorporating these broader benefits.

AREAS COVERED

This review presents the broader value domains proposed in literature by various frameworks, and their definitions. The review of economic evidence of vaccine use in India to discuss to what extent these broader value domains have been considered in economic evaluations in India has been presented. We also discuss specific considerations that need to be taken care of while developing value frameworks or guidelines for the economic evaluation of vaccines.

EXPERT OPINION

To develop a comprehensive framework tailored to the country needs, prioritize relevant value domains and optimal methodologies based on the country's healthcare context, and data availability. These value domains must align with people's as well as decision-makers preferences to ensure economic assessments are relevant and actionable.

Cost-Effectiveness Analysis of Pneumococcal Vaccines in the Pediatric Population: A Systematic Review

Objectives: Pneumococcal disease, caused by Streptococcus pneumoniae, is the leading cause of mortality in children worldwide. The tremendous direct cost of hospital admissions and significant indirect costs from productivity loss contribute considerably to its economic burden, with vaccination being the only efficient protection against the illness. Our study aims to summarize the cost-effectiveness of the pneumococcal conjugate vaccine (PCV) implemented in the pediatric population. Methods: Employing the online databases PubMed, Embase, and Medline, we looked for economic evaluations from 2018 until March 2024. The Incremental Cost-Effectiveness Ratios (ICER) and Quality-Adjusted Life Years (QALY) were the primary outcomes for measuring the cost-effectiveness of PCVs. A 28-item CHEERS 2022 checklist was applied to assess the quality of the collected studies. Results: Of the 16 papers found, 9/16 discussed the lower-valent vaccines (PCV13, PCV10) and 7/16 examined the higher-valent vaccines (PCV20, PCV15). PCV13 and PCV10 involved greater costs and generated more QALY compared to no vaccination. Both PCV15 and PCV20 averted substantial healthcare costs and yielded greater quality of life than PCV13. Additionally, PCV20 was a dominant strategy compared to PCV15. Conclusions: Utilizing PCV13 is a very cost-effective option compared to not getting vaccinated. Transitioning from PCV13 to PCV20 would result in higher QALY gain and more cost-saving than switching to PCV15.

Developing a roadmap to reach and sustain 90% full immunization coverage through a cross-sectoral system strengthening strategy in Bihar, India

INTRODUCTION

Reducing childhood mortality by curtailing the incidence of vaccine preventable diseases is contingent upon a robust and high-performing routine immunization system. According to the available data, the full immunization coverage (FIC) in the state of Bihar (India) has reached ~ 71%. While the government aspires to reach 90% FIC, a systematic evidence-based investigation of the reasons behind underimmunization as well as the identification of drivers and enablers to reach and sustain 90% FIC is critical. This study aimed to review the factors leading to underimmunized children in the state of Bihar and develop a forward-looking roadmap to reach and sustain 90% FIC by adopting a system strengthening approach.

METHOD

We conducted a desk review, followed by extensive stakeholder interviews and field visits to document and analyze the data and evidence relevant to routine immunization system performance in the state of Bihar. The stakeholders included the State Immunization Officer, District Immunization Officers, Block-level health officials, representatives from development agencies, healthcare workers, and caregivers. A total of eighty-six structured interviews were conducted, which included qualitative and quantitative parameters.

RESULT

While positive results were observed from the assessment of Bihar's immunization system, the implementation of targeted strategies for supply, service delivery and demand can provide a means to achieve FIC of 90%. The roadmap developed by the Government of Bihar enlists 40 + interventions across key thematic areas and has been prioritized over a 5-year time horizon as short, medium, and long-term milestones to achieve 90% FIC. These interventions include strengthening the data availability and quality, improving the governance and review mechanism, augmenting the capacity of health workers involve with immunization programme, and initiatives to increase demand for immunization services.

CONCLUSION

The Bihar's Immunization Roadmap development project work follows a methodical approach to assess and identify intervention to improve immunization coverage and can provide information and reference to other states and countries that are aiming to formulate similar action plans.