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King DF, Groves H, Weller C, Jones I, Cramer JP, Gilbert PB, Goldblatt D, Gruber MF, Kampmann B, Maïga D, Pasetti MF, Plotkin SA, Precioso A, Wassie L, Wittke F, Kaslow DC. Realising the potential of correlates of protection for vaccine development, licensure and use: short summary. NPJ Vaccines 2024; 9:82. [PMID: 38684704 PMCID: PMC11058756 DOI: 10.1038/s41541-024-00872-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/20/2024] [Indexed: 05/02/2024] Open
Affiliation(s)
| | | | | | - Ian Jones
- WHO consultant, Jinja Publishing Ltd, London, UK
| | - Jakob P Cramer
- Coalition for Epidemic Preparedness Innovations (CEPI), 215 Euston Road, London, NW1 2BE, UK
| | - Peter B Gilbert
- Vaccine Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - David Goldblatt
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Marion F Gruber
- International AIDS Vaccine Initiative (IAVI), 125 Broad Street, New York, NY, 10004, USA
| | - Beate Kampmann
- London School of Hygiene & Tropical Medicine (LSHTM) Keppel Street, London, WC1E 7HT, United Kingdom
| | - Diadié Maïga
- World Health Organization (WHO) - Regional Office for Africa, Cité du Djoué, P.O.Box 06, Brazzaville, Republic of Congo
| | - Marcela F Pasetti
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Alexander Precioso
- Instituto Butantan1500, Vital Brasil Avenue, Butantã, São Paulo, SP, 05503900, Brazil
| | - Liya Wassie
- Armauer Hansen Research Institute, Jimma Road, ALERT Campus, Addis Ababa, Ethiopia
| | | | - David C Kaslow
- PATH 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
- US FDA, Seattle, WA, 98121, USA
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King DF, Groves H, Weller C. The role of correlates of protection in overcoming barriers to vaccine development and demonstrating efficacy. NPJ Vaccines 2024; 9:78. [PMID: 38615121 PMCID: PMC11016058 DOI: 10.1038/s41541-024-00873-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/28/2024] [Indexed: 04/15/2024] Open
Affiliation(s)
- Deborah F King
- Infection Disease Strategic Programme, Wellcome, 215 Euston Road, London, UK.
| | - Helen Groves
- Infection Disease Strategic Programme, Wellcome, 215 Euston Road, London, UK
| | - Charlotte Weller
- Infection Disease Strategic Programme, Wellcome, 215 Euston Road, London, UK
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Means AR, List K, Roll A, Gwayi-Chore MC, Dolley S, Schünemann HJ, Norman TC, Walson JL. Participatory development of a target policy profile to support soil-transmitted helminth elimination. FRONTIERS IN HEALTH SERVICES 2024; 3:1310694. [PMID: 38313331 PMCID: PMC10836137 DOI: 10.3389/frhs.2023.1310694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/21/2023] [Indexed: 02/06/2024]
Abstract
Introduction Soil-transmitted helminths (STH) are parasitic worms that infect nearly a quarter of the world's population, particularly those living in communities without access to adequate water, sanitation, and housing. Emerging evidence suggests that it may be possible to interrupt transmission of STH by deworming individuals of all ages via community-wide MDA (cMDA), as opposed to only treating children and other focal populations. Transitioning from a policy of STH control to STH elimination in targeted areas would require a fundamental shift in STH policy and programming. This policy change would require updated guidance to support countries as they adapt their current approaches for STH surveillance, supply chain management, community mobilization, and core programmatic activities in pursuit of STH elimination. There is an opportunity to engage with key stakeholders, such as program implementers and implementation partners, to understand what evidence they need to confidently adopt a new policy guideline and to deliver guideline adherent management at scale. Methods We aimed to engage with STH stakeholders to develop a Target Policy Profile (TPoP), a single document that describes optimal characteristics and evidence requirements that STH stakeholders prioritized in future potential STH transmission interruption efforts. Steps in TPoP development included a scoping review and key informant interviews (KIIs), which were used to design a two-stage Delphi technique to identify and verify TPoP components. Results The scoping review resulted in 25 articles, and 8 experts participated in KII's. Twenty respondents completed the first Delphi survey and 10 respondents completed the second. This systematic effort resulted in a net of 3 key information domains (background/context, clinical considerations, and implementation considerations) encompassing 24 evidence categories (examples include evidence regarding safety and adverse events, implementation feasibility, or evidence dissemination). For each evidence category, STH stakeholders reviewed, endorsed, or revised a range of options for how the evidence could be presented. Discussion This information can be used by guideline committees or global policy makers prior to convening guideline advisory groups. The TPoP tool may also speed the process of stakeholder consensus building around guidelines, accelerating progress towards implementing evidence-based policy at scale.
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Affiliation(s)
- Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, WA, United States
- The DeWorm3 Project, University of Washington, Seattle, WA, United States
| | - Kellie List
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Amy Roll
- Department of Global Health, University of Washington, Seattle, WA, United States
- The DeWorm3 Project, University of Washington, Seattle, WA, United States
| | - Marie-Claire Gwayi-Chore
- Department of Global Health, University of Washington, Seattle, WA, United States
- The DeWorm3 Project, University of Washington, Seattle, WA, United States
| | - Shawn Dolley
- Open Global Health, Arlington, VA, United States
| | - Holger J. Schünemann
- Departmentof Health Research Methods, Evidence, and Impact, and of Medicine, McMaster University, Hamilton, ON, Canada
- McMaster GRADE Centre & Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Thea C. Norman
- Bill & Melinda Gates Foundation, Seattle, WA, United States
| | - Judd L. Walson
- Department of Global Health, University of Washington, Seattle, WA, United States
- The DeWorm3 Project, University of Washington, Seattle, WA, United States
- Departments of Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, WA, United States
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Fu H, Abbas K, Malvolti S, Gregory C, Ko M, Amorij JP, Jit M. Impact and cost-effectiveness of measles vaccination through microarray patches in 70 low-income and middle-income countries: mathematical modelling and early-stage economic evaluation. BMJ Glob Health 2023; 8:e012204. [PMID: 37949503 PMCID: PMC10649680 DOI: 10.1136/bmjgh-2023-012204] [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: 03/06/2023] [Accepted: 10/01/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Microarray patches (MAPs) are a promising technology being developed to reduce barriers to vaccine delivery based on needles and syringes (N&S). To address the evidence gap on the public health value of applying this potential technology to immunisation programmes, we evaluated the health impact on measles burden and cost-effectiveness of introducing measles-rubella MAPs (MR-MAPs) in 70 low-income and middle-income countries (LMICs). METHODS We used an age-structured dynamic model of measles transmission and vaccination to project measles cases, deaths and disability-adjusted life-years during 2030-2040. Compared with the baseline scenarios with continuing current N&S-based practice, we evaluated the introduction of MR-MAPs under different measles vaccine coverage projections and MR-MAP introduction strategies. Costs were calculated based on the ingredients approach, including direct cost of measles treatment, vaccine procurement and vaccine delivery. Model-based burden and cost estimates were derived for individual countries and country income groups. We compared the incremental cost-effectiveness ratios of introducing MR-MAPs to health opportunity costs. RESULTS MR-MAP introduction could prevent 27%-37% of measles burden between 2030 and 2040 in 70 LMICs, compared with the N&S-only immunisation strategy. The largest health impact could be achieved under lower coverage projection and accelerated introduction strategy, with 39 million measles cases averted. Measles treatment cost is a key driver of the net cost of introduction. In countries with a relatively higher income, introducing MR-MAPs could be a cost-saving intervention due to reduced treatment costs. Compared with country-specific health opportunity costs, introducing MR-MAPs would be cost-effective in 16%-81% of LMICs, depending on the MR-MAPs procurement prices and vaccine coverage projections. CONCLUSIONS Introducing MR-MAPs in LMICs can be a cost-effective strategy to revitalise measles immunisation programmes with stagnant uptake and reach undervaccinated children. Sustainable introduction and uptake of MR-MAPs has the potential to improve vaccine equity within and between countries and accelerate progress towards measles elimination.
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Affiliation(s)
- Han Fu
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Kaja Abbas
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Public Health Foundation of India, New Delhi, India
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | | | - Melissa Ko
- MMGH Consulting GmbH, Zurich, Switzerland
| | | | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
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Nelson KN, Churchyard G, Cobelens F, Hanekom WA, Hill PC, Lopman B, Mave V, Rangaka MX, Vekemans J, White RG, Wong EB, Martinez L, García-Basteiro AL. Measuring indirect transmission-reducing effects in tuberculosis vaccine efficacy trials: why and how? THE LANCET. MICROBE 2023; 4:e651-e656. [PMID: 37329893 PMCID: PMC10393779 DOI: 10.1016/s2666-5247(23)00112-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 02/24/2023] [Accepted: 03/27/2023] [Indexed: 06/19/2023]
Abstract
Tuberculosis is the leading bacterial cause of death globally. In 2021, 10·6 million people developed symptomatic tuberculosis and 1·6 million died. Seven promising vaccine candidates that aim to prevent tuberculosis disease in adolescents and adults are currently in late-stage clinical trials. Conventional phase 3 trials provide information on the direct protection conferred against infection or disease in vaccinated individuals, but they tell us little about possible indirect (ie, transmission-reducing) effects that afford protection to unvaccinated individuals. As a result, proposed phase 3 trial designs will not provide key information about the overall effect of introducing a vaccine programme. Information on the potential for indirect effects can be crucial for policy makers deciding whether and how to introduce tuberculosis vaccines into immunisation programmes. We describe the rationale for measuring indirect effects, in addition to direct effects, of tuberculosis vaccine candidates in pivotal trials and lay out several options for incorporating their measurement into phase 3 trial designs.
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Affiliation(s)
- Kristin N Nelson
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA.
| | | | - Frank Cobelens
- Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | | | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Benjamin Lopman
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - Vidya Mave
- Johns Hopkins Center for Infectious Diseases in India, Pune, India
| | - Molebogeng X Rangaka
- Institute for Global Health and MRC Clinical Trials Unit, University College London, London, UK
| | | | - Richard G White
- Tuberculosis Modelling Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily B Wong
- Africa Health Research Institute, KwaZulu Natal, South Africa; Division of Infectious Diseases, Department of Medicine, Heersink School of Medicine, University of Alabama Birmingham, Birmingham, AL, USA
| | - Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - Alberto L García-Basteiro
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique; ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
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Hutubessy R, Lauer JA, Giersing B, Sim SY, Jit M, Kaslow D, Botwright S. The Full Value of Vaccine Assessments (FVVA): a framework for assessing and communicating the value of vaccines for investment and introduction decision-making. BMC Med 2023; 21:229. [PMID: 37400797 PMCID: PMC10318807 DOI: 10.1186/s12916-023-02929-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/08/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Several economic obstacles can deter the development and use of vaccines. This can lead to limited product options for some diseases, delays in new product development, and inequitable access to vaccines. Although seemingly distinct, these obstacles are actually interrelated and therefore need to be addressed through a single over-arching strategy encompassing all stakeholders. METHODS To help overcome these obstacles, we propose a new approach, the Full Value of Vaccines Assessments (FVVA) framework, to guide the assessment and communication of the value of a vaccine. The FVVA framework is designed to facilitate alignment across key stakeholders and to enhance decision-making around investment in vaccine development, policy-making, procurement, and introduction, particularly for vaccines intended for use in low- and middle-income countries. RESULTS The FVVA framework has three key elements. First, to enhance assessment, existing value-assessment methods and tools are adapted to include broader benefits of vaccines as well as opportunity costs borne by stakeholders. Second, to improve decision-making, a deliberative process is required to recognize the agency of stakeholders and to ensure country ownership of decision-making and priority setting. Third, the FVVA framework provides a consistent and evidence-based approach that facilitates communication about the full value of vaccines, helping to enhance alignment and coordination across diverse stakeholders. CONCLUSIONS The FVVA framework provides guidance for stakeholders organizing global-level efforts to promote investment in vaccines that are priorities for LMICs. By providing a more holistic view of the benefits of vaccines, its application also has the potential to encourage greater take-up by countries, thereby leading to more sustainable and equitable impacts of vaccines and immunization programmes.
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Affiliation(s)
- Raymond Hutubessy
- Immunization, Vaccines and Biologicals Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva, Switzerland
| | - Jeremy A. Lauer
- Strathclyde Business School, University of Strathclyde, Glasgow, UK
| | - Birgitte Giersing
- Immunization, Vaccines and Biologicals Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva, Switzerland
| | - So Yoon Sim
- Immunization, Vaccines and Biologicals Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva, Switzerland
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - David Kaslow
- PATH Center for Vaccine Innovation and Access, Seattle, USA
| | - Siobhan Botwright
- Immunization, Vaccines and Biologicals Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva, Switzerland
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Sinnis P, Fidock DA. The RTS,S vaccine-a chance to regain the upper hand against malaria? Cell 2022; 185:750-754. [PMID: 35245476 DOI: 10.1016/j.cell.2022.01.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 10/18/2022]
Abstract
Malaria is estimated by the World Health Organization (WHO) to have killed 627,000 individuals worldwide in 2020, with nearly 80% of deaths in African children younger than five. The recent WHO approval of the RTS,S/AS01 vaccine, which targets Plasmodium falciparum pre-erythrocytic stages, provides hope that its use combined with other interventions can help reverse the current malaria resurgence.
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Affiliation(s)
- Photini Sinnis
- Johns Hopkins Malaria Research Institute and Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - David A Fidock
- Department of Microbiology and Immunology, Columbia University Irving Medical Center, New York, NY 10032, USA; Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA.
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