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Perrin JM, Flanagan P, Katkin J, Barabell G, Price J. The Unique Value Proposition of Pediatric Health Care. Pediatrics 2023; 151:190498. [PMID: 36995185 DOI: 10.1542/peds.2022-060681] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
This document provides a framework for the value proposition of pediatric health care. It is intended to provide a succinct set of principles for establishing this proposition that demonstrates the short- and long-term value to the child and family, the health care system, and society as a whole.
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Affiliation(s)
- James M Perrin
- MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Patricia Flanagan
- W. Alpert Medical School of Brown University/Hasbro Children's Hospital Department of Pediatrics, Providence, Rhode Island
| | - Julie Katkin
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Jonathan Price
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
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Ota MOC, de Moraes JC, Vojtek I, Constenla D, Doherty TM, Cintra O, Kirigia JM. Unveiling the contributions of immunization for progressing towards Universal Health Coverage. Hum Vaccin Immunother 2022; 18:2036048. [PMID: 35239460 PMCID: PMC9009948 DOI: 10.1080/21645515.2022.2036048] [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: 11/04/2022] Open
Abstract
The aim of the United Nations' Sustainable Development Goal (SDG)3 is to ensure healthy lives and promote well-being for all, at all ages; including reducing maternal and child mortality, combating communicable and non-communicable diseases, and achieving Universal Health Coverage (UHC). UHC aims to provide everyone with equal access to quality essential and comprehensive healthcare services including preventions, interventions, and treatments, without exposing them to financial hardship. Making progress toward UHC requires significant investment in technical and financial resources and countries are pursuing the implementation of cost-saving measures within health systems to help them achieve UHC. Whilst many countries are far from attaining UHC, all countries, particularly low- and middle-income countries, can take steps toward achieving UHC. This paper discusses key data showing how immunization is a fundamental, cost-effective tool for reducing morbidity and mortality associated with infectious disease in all populations, creating more productive communities, reducing treatment costs, and consequently, facilitating social and economic advancement. Immunization is key to advancing toward UHC by relieving the burden that diseases place on the healthcare services, freeing essential resources to use elsewhere within the healthcare system. Immunization is an essential, readily available strategy that countries can deploy to achieve UHC and the SDG3 agenda.
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Affiliation(s)
| | - Jose C de Moraes
- Department of Collective Health, Faculty of Medical Sciences of Santa Casa de Sao Paulo, Sao Paulo, Brazil
| | - Ivo Vojtek
- Medical Affairs, GSK, Medical Affairs, Wavre, Belgium
| | - Dagna Constenla
- Medical Affairs, GSK, US Research & Development, Saloui Center, Rockville, MD,USA
| | - T Mark Doherty
- Medical Affairs, GSK, Medical Affairs, Brondfby, Denmark
| | - Otavio Cintra
- Medical Affairs, GSK, Medical Affairs, Rio de Janeiro, Brazil
| | - Joses M Kirigia
- African Sustainable Development Research Consortium (ASDRC), Nairobi, Kenya
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da Costa ÉSM, Hyeda A, Maluf EMCP. Costs related to immunopreventable diseases: Brazil and its geographic areas (immunopreventable diseases' costs in Brazil). BMC Health Serv Res 2021; 21:1165. [PMID: 34706728 PMCID: PMC8555006 DOI: 10.1186/s12913-021-07117-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The occurrence of the immunopreventable diseases in a population global reality. OBJECTIVE To discriminate the direct costs of the hospitalizations from the immunopreventable diseases in the Unified Health System (SUS), in Brazil and their areas, between 2008 and 2018. METHODS A population, observational, descriptive and retrospective study, with data from the information supplied by the DATASUS website, these data were collected during the 2019. RESULTS It was identified 457,479 hospitalizations in the period; with a total of 2,450,870 days of hospital stay, with total costs of R$389,243,264.85. Only the disease mumps presented a growing tendency in whole areas; the chickenpox was decreasing; the illness whooping cough, yellow fever and tetanus were stationary in this period. CONCLUSIONS The costs related to immunopreventable diseases were relevant in all the Brazil areas, with tendencies different between the geographic areas and between the several illnesses analysed.
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Affiliation(s)
- Élide Sbardellotto M da Costa
- Department of Internal Medicine Post-graduation, Federal University of Paraná, General Carneiro Street, 181, Curitiba, Paraná, Brazil.
| | - Adriano Hyeda
- Internal Medicine, Federal university of Paraná (UFPR), Health Management by Superior Institute of Management and Economy / Getúlio Vargas Foundation (ISAE/FGV), Curitiba, Brazil
| | - Eliane M C P Maluf
- Pos-geraduation Program in Internal Medicine, Federal University of Paraná (UFPR), Curitiba, Brazil
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Monetary Valuation of Children's Cognitive Outcomes in Economic Evaluations from a Societal Perspective: A Review. CHILDREN-BASEL 2021; 8:children8050352. [PMID: 33946651 PMCID: PMC8146900 DOI: 10.3390/children8050352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 01/12/2023]
Abstract
Cognitive ability in childhood is positively associated with economic productivity in adulthood. Expected gains in economic output from interventions that protect cognitive function can be incorporated in benefit-cost and cost-effectiveness analyses conducted from a societal perspective. This review summarizes estimates from high-income countries of the association of general cognitive ability, standardized as intelligence quotient (IQ), with annual and lifetime earnings among adults. Estimates of the association of adult earnings with cognitive ability assessed in childhood or adolescence vary from 0.5% to 2.5% per IQ point. That range reflects differences in data sources and analytic methods. We take a conservative published estimate of a 1.4% difference in market productivity per IQ point in the United States from a recent study that controlled for confounding by family background and behavioral attributes. Using that estimate and the present value of lifetime earnings calculated using a 3% discount rate, the implied lifetime monetary valuation of an IQ point in the United States is USD 10,600-13,100. Despite uncertainty and the exclusion of non-market productivity, incorporation of such estimates could lead to a fuller assessment of the benefits of public health and clinical interventions that protect the developing brains of fetuses, infants, and young children.
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Niessen LW, Taylor ML. Eliminating Lymphatic Filariasis: Is it Worth it? Clin Infect Dis 2021; 70:2568-2569. [PMID: 31343066 DOI: 10.1093/cid/ciz674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 01/25/2023] Open
Affiliation(s)
- Louis Wilhelmus Niessen
- Department of International Public Health and Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, United Kingdom
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mark L Taylor
- Department of International Public Health and Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, United Kingdom
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Watts E, Sim SY, Constenla D, Sriudomporn S, Brenzel L, Patenaude B. Economic Benefits of Immunization for 10 Pathogens in 94 Low- and Middle-Income Countries From 2011 to 2030 Using Cost-of-Illness and Value-of-Statistical-Life Approaches. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:78-85. [PMID: 33431157 DOI: 10.1016/j.jval.2020.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/23/2020] [Accepted: 07/12/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Vaccination has prevented millions of deaths and cases of disease in low- and middle-income countries (LMICs). During the Decade of Vaccines (2011-2020), international organizations, including the World Health Organization and Gavi, the Vaccine Alliance, focused on new vaccine introduction and expanded coverage of existing vaccines. As Gavi, other organizations, and country governments look to the future, we aimed to estimate the economic benefits of immunization programs made from 2011 to 2020 and potential gains in the future decade. METHODS We used estimates of cases and deaths averted by vaccines against 10 pathogens in 94 LMICs to estimate the economic value of immunization. We applied 3 approaches-cost of illness averted (COI), value of statistical life (VSL), and value of statistical life-year (VSLY)-to estimate observable and unobservable economic benefits between 2011 and 2030. RESULTS From 2011 to 2030, immunization would avert $1510.4 billion ($674.3-$2643.2 billion) (2018 USD) in costs of illness in the 94 modeled countries, compared with the counterfactual of no vaccination. Using the VSL approach, immunization would generate $3436.7 billion ($1615.8-$5657.2 billion) in benefits. Applying the VSLY approach, $5662.7 billion ($2547.2-$9719.4) in benefits would be generated. CONCLUSION Vaccination has generated significant economic benefits in LMICs in the past decade. To reach predicted levels of economic benefits, countries and international donor organizations need to meet coverage projections outlined in the Gavi Operational Forecast. Estimates generated using the COI, VSL, or VSLY approach may be strategically used by donor agencies, decision makers, and advocates to inform investment cases and advocacy campaigns.
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Affiliation(s)
- 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.
| | - So Yoon Sim
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneve, GE, CH
| | | | - Salin Sriudomporn
- 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 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
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Azam JM, Are EB, Pang X, Ferrari MJ, Pulliam JRC. Outbreak response intervention models of vaccine-preventable diseases in humans and foot-and-mouth disease in livestock: a protocol for a systematic review. BMJ Open 2020; 10:e036172. [PMID: 33020081 PMCID: PMC7537453 DOI: 10.1136/bmjopen-2019-036172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Outbreaks of vaccine-preventable diseases continue to threaten public health, despite the proven effectiveness of vaccines. Interventions such as vaccination, social distancing and palliative care are usually implemented, either individually or in combination, to control these outbreaks. Mathematical models are often used to assess the impact of these interventions and for supporting outbreak response decision making. The objectives of this systematic review, which covers all human vaccine-preventable diseases, are to determine the relative impact of vaccination compared with other outbreak interventions, and to ascertain the temporal trends in the use of modelling in outbreak response decision making. We will also identify gaps and opportunities for future research through a comparison with the foot-and-mouth disease outbreak response modelling literature, which has good examples of the use of modelling to inform outbreak response intervention decision making. METHODS AND ANALYSIS We searched on PubMed, Scopus, Web of Science, Google Scholar and some preprint servers from the start of indexing to 15 January 2020. Inclusion: modelling studies, published in English, that use a mechanistic approach to evaluate the impact of an outbreak intervention. Exclusion: reviews, and studies that do not describe or use mechanistic models or do not describe an outbreak. We will extract data from the included studies such as their objectives, model types and composition, and conclusions on the impact of the intervention. We will ascertain the impact of models on outbreak response decision making through visualisation of time trends in the use of the models. We will also present our results in narrative style. ETHICS AND DISSEMINATION This systematic review will not require any ethics approval since it only involves scientific articles. The review will be disseminated in a peer-reviewed journal and at various conferences fitting its scope. PROSPERO REGISTRATION NUMBER CRD42020160803.
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Affiliation(s)
- James M Azam
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Elisha B Are
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Xiaoxi Pang
- Department of Mathematics, The University of Manchester, Manchester, UK
| | - Matthew J Ferrari
- Center for Infectious Disease Dynamics, Department of Biology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Juliet R C Pulliam
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Cape Town, Western Cape, South Africa
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Obregon R, Mosquera M, Tomsa S, Chitnis K. Vaccine Hesitancy and Demand for Immunization in Eastern Europe and Central Asia: Implications for the Region and Beyond. JOURNAL OF HEALTH COMMUNICATION 2020; 25:808-815. [PMID: 33719888 DOI: 10.1080/10810730.2021.1879366] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Immunization is a global success story. It has saved millions of lives and prevented disease worldwide and millions more have been spared the permanent disabilities caused by diseases such as polio and the long-term morbidity caused by other diseases such as measles. Despite the compelling evidence of the public health and economic value of vaccines, vaccine hesitancy has become a growing concern globally. By calling into question the safety and efficacy of vaccines, vaccine hesitancy threatens the progress made in combating morbidity and mortality including efforts to introduce COVID-19 vaccines. This paper a) examines key factors that drive limited demand for vaccines and vaccine hesitancy, (b) highlights the role of demand promotion for immunization and of risk communication and community engagement to address those challenges, (c) discusses vaccine demand and hesitancy in Eastern Europe and Central Asia, and (d) makes recommendations for public health policy and programming for the introduction of the COVID-19 vaccine and beyond.Recommendations include strengthen social listening and digital engagement to address the concerns of caregivers and healthcare professionals, improve the availability and use of social data for evidence-based programming, reinforce public trust in health institutions and service providers, mainstream demand for immunization, strengthen the communication competencies of health service providers, test and apply solutions based on behavioral insights to reinforce demand, engage regularly with local governments and local actors, and strengthen resilience and response capacities for diseases outbreaks and public health emergencies.
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Affiliation(s)
- Rafael Obregon
- Country Representative, UNICEF Paraguay, Asuncion, Paraguay
| | - Mario Mosquera
- Communication for Development, UNICEF East and Central Asia Regional Office, Geneva, Switzerland
| | - Sergiu Tomsa
- Communication for Development Specialist, UNICEF East and Central Asia Regional Office, Geneva, Switzerland
| | - Ketan Chitnis
- Communication for Development, UNICEF Mozambique, Maputo, Mozambique
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Sarker AR, Sultana M. Cost-effective analysis of childhood malaria vaccination in endemic hotspots of Bangladesh. PLoS One 2020; 15:e0233902. [PMID: 32470101 PMCID: PMC7259743 DOI: 10.1371/journal.pone.0233902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/14/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Bangladesh has a history of endemic malaria transmission, with 17.5 million people at risk. The objective of this study was to assess the cost-effectiveness of universal childhood malaria vaccination in Chittagong Hill Tracts (CHT) of Bangladesh with newly developed RTS,S/AS01 malaria vaccines. METHODS A decision model was been developed using Microsoft® Excel to examine the potential impact of future vaccination in Bangladesh. We estimated the economic and health burden due to malaria and the cost-effectiveness of malaria vaccination from the health system and societal perspective. The primary outcomes include the incremental cost per Disability-Adjusted Life Year (DALY) averted, incremental cost per case averted, and the incremental cost per death averted. RESULTS Introducing childhood malaria vaccination in CHT in Bangladesh for a single birth cohort could prevent approximately 500 malaria cases and at least 30 deaths from malaria during the first year of vaccination. The cost per DALY averted of introducing the malaria vaccine compared to status quo is US$ 2,629 and US$ 2,583 from the health system and societal perspective, respectively. CONCLUSIONS Introduction of malaria vaccination in CHT region is estimated to be a cost-effective preventive intervention and would offer substantial future benefits particularly for young children vaccinated today. Policies should, thus, consider the operational advantages of targeting these populations, particularly in the CHT area, with the vaccine along with other malaria control initiatives.
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Affiliation(s)
- Abdur Razzaque Sarker
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Marufa Sultana
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- School of Health and Social Development, Deakin University, Burwood, Melbourne, Australia
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The Effects of Pre-Existing Antibodies on Live-Attenuated Viral Vaccines. Viruses 2020; 12:v12050520. [PMID: 32397218 PMCID: PMC7290594 DOI: 10.3390/v12050520] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/11/2022] Open
Abstract
Live-attenuated vaccines (LAVs) have achieved remarkable successes in controlling virus spread, as well as for other applications such as cancer immunotherapy. However, with rapid increases in international travel, globalization, geographic spread of viral vectors, and widespread use of vaccines, there is an increasing need to consider how pre-exposure to viruses which share similar antigenic regions can impact vaccine efficacy. Pre-existing antibodies, derived from either from maternal–fetal transmission, or by previous infection or vaccination, have been demonstrated to interfere with vaccine immunogenicity of measles, adenovirus, and influenza LAVs. Immune interference of LAVs can be caused by the formation of virus–antibody complexes that neutralize virus infection in antigen-presenting cells, or by the cross-linking of the B-cell receptor with the inhibitory receptor, FcγRIIB. On the other hand, pre-existing antibodies can augment flaviviral LAV efficacy such as that of dengue and yellow fever virus, especially when pre-existing antibodies are present at sub-neutralizing levels. The increased vaccine immunogenicity can be facilitated by antibody-dependent enhancement of virus infection, enhancing virus uptake in antigen-presenting cells, and robust induction of innate immune responses that promote vaccine immunogenicity. This review examines the literature on this topic and examines the circumstances where pre-existing antibodies can inhibit or enhance LAV efficacy. A better knowledge of the underlying mechanisms involved could allow us to better manage immunization in seropositive individuals and even identify possibilities that could allow us to exploit pre-existing antibodies to boost vaccine-induced responses for improved vaccine efficacy.
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Sarker AR, Islam Z, Sultana M, Sheikh N, Mahumud RA, Islam MT, Meer RVD, Morton A, Khan AI, Clemens JD, Qadri F, Khan JAM. Willingness to pay for oral cholera vaccines in urban Bangladesh. PLoS One 2020; 15:e0232600. [PMID: 32353086 PMCID: PMC7192494 DOI: 10.1371/journal.pone.0232600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 04/17/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Cholera is a highly infectious disease and remains a serious public health burden in Bangladesh. The objective of the study was to measure the private demand for oral cholera vaccines (OCV) in Bangladesh and to investigate the key determinants of this demand, reflected in the household’s willingness to pay (WTP) for oral cholera vaccine. Methods A contingent valuation method was employed in an urban setting of Bangladesh during December 2015 to January 2016. All respondents (N = 1051) received a description of World Health Organization (WHO) prequalified OCV, Shanchol™. Interviews were conducted with either the head of households or their spouse or a major economic contributor of the households. Respondents were asked about how much at maximum they were willing to pay for OCV for their own and their household members’ protection. Results are presented as the average and median of the reported maximum WTP of the respondents with standard deviations and 95% confidence interval. Natural log-linear regression model was employed to examine the factors influencing participants’ WTP for OCV. Results About 99% of the respondents expressed WTP for OCV with a maximum mean and median WTP per vaccination (2 doses) of US$ 2.23 and US$ 1.92 respectively. On the household level with an average number of 4.62 members, the estimated mean WTP was US$ 10 (median: US$ 7.69) which represents the perceived demand for OCV of a household to vaccinate against cholera. Conclusions The demand of vaccination further indicates that there is a potential scope for recovering a certain portion of the expenditure of immunization program by introducing direct user fees for future cholera vaccination in Bangladesh. Findings from this study will be useful for the policy-makers to make decision on cost-recovery in future oral cholera vaccination programs in Bangladesh and in similar countries.
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Affiliation(s)
- Abdur Razzaque Sarker
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- University of Strathclyde, Glasgow, United Kingdom
- Bangladesh Institute of Development Studies, Dhaka, Bangladesh
- * E-mail:
| | - Ziaul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Marufa Sultana
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nurnabi Sheikh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Md. Taufiqul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Alec Morton
- University of Strathclyde, Glasgow, United Kingdom
| | - Ashraful Islam Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - John David Clemens
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jahangir A. M. Khan
- Karolinska Institute, Solna, Stockholm, Sweden
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Pierce H. Nurturing Care for Early Childhood Development: Path to Improving Child Outcomes in Africa. POPULATION RESEARCH AND POLICY REVIEW 2020. [DOI: 10.1007/s11113-020-09581-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Ntenda PAM. Factors associated with non- and under-vaccination among children aged 12-23 months in Malawi. A multinomial analysis of the population-based sample. Pediatr Neonatol 2019; 60:623-633. [PMID: 31040068 DOI: 10.1016/j.pedneo.2019.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/15/2018] [Accepted: 03/14/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Non- and under-vaccination among children in Malawi have received little attention. Between 2010 and 2016, the proportion of children who received full immunization before their first birthday dropped from 81% to 76% in Malawi. This signifies that a certain fraction of children are either non-vaccinated or under-vaccinated. Thus, the present study attempted to examine the predictors of non- and under-vaccination among children aged 12-23 months in Malawi. METHODS Cross-sectional data obtained from the Malawi Demographic and Health Survey 2015-16 were utilized. The percentage of children aged 12-23 months who were non-vaccinated, under-vaccinated, or fully vaccinated with 1 dose of Bacillus Calmette-Guérin, 3 doses of oral polio vaccine, 3 doses of pentavalent, 2 doses of rotavirus vaccine, 3 doses of pneumococcal vaccine and 1 dose of measles-containing vaccine were calculated. The odds of being non-vaccinated and under-vaccinated compared to full vaccination relative to various sociodemographic factors were assessed using a multivariable multinomial logistic regression with logit link function which accounted for survey design. RESULTS Of 3111 children aged 12-23 months, 72% were fully vaccinated, 26% were under-vaccinated, and about 2% were non-vaccinated. The multinomial logistic regression showed that children from the poorest households, and children who did not have postnatal care within two months had increased odds of being under-vaccinated. On the other hand, children who had no health card or whose card was lost had increased odds of being both non- and under-vaccinated. Additionally, children from the northern region and who resided in households with either none or one under-five child had reduced odds of being non-vaccinated and under-vaccinated, respectively. CONCLUSIONS Women from the poorest households and those who are not attending PNC should be targeted when designing interventions that aim at improving childhood vaccination in order to reduce the barriers they face in accessing vaccination services.
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Affiliation(s)
- Peter Austin Morton Ntenda
- School of Public Health, Taipei Medical University, College of Public Health, No. 250, Wu-Hsing St, Taipei City 11031, Taiwan.
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Estimating the economic impact of pneumococcal conjugate, Haemophilus influenzae type b and rotavirus vaccines in India: National and state-level analyses. Vaccine 2019; 37:7547-7559. [DOI: 10.1016/j.vaccine.2019.09.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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WITHDRAWN: Estimating the economic impact of pneumococcal conjugate, Haemophilus influenzae type b and rotavirus vaccines in India: National and state-level analyses. Vaccine X 2019. [DOI: 10.1016/j.jvacx.2019.100044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Nsubuga F, Kabwama SN, Ampeire I, Luzze H, Gerald P, Bulage L, Toliva OB. Comparing static and outreach immunization strategies and associated factors in Uganda, Nov-Dec 2016. Pan Afr Med J 2019; 32:123. [PMID: 31223412 PMCID: PMC6561008 DOI: 10.11604/pamj.2019.32.123.16093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 12/12/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction the government of Uganda aims at reducing childhood morbidity through provision of immunization services. We compared the proportion of children 12-33 months reached using either static or outreach immunization strategies and factors affecting utilization of routine vaccination services in order to inform policy updates. Methods we adopted the 2015 vaccination coverage cluster survey technique. The sample selection was based on a stratified three-stage sample design. Using the Fleiss formula, a sample of 50 enumeration areas was sufficient to generate immunization coverages at each region. A total of 200 enumeration areas were selected for the survey. Thirty households were selected per enumeration area. Epi-Info software was used to calculate weighted coverage estimates. facility. Results among the 2231 vaccinated children aged 12-23 months who participated in the survey, 68.1% received immunization services from a health unit and 10.6% from outreaches. The factors that affected utilization of routine vaccination services were; accessibility, where 78.2% resided within 5km from a health. 29.7% missed vaccination due to lack of vaccines at the health facility. Other reasons were lack of supplies at 39.2% and because the caretaker had other things to do, 26.4%. The survey showed 1.8% (40/2271) respondents had not vaccinated their children. Among these, 70% said they had not vaccinated their child because they were busy doing other things and 27.5% had not done so because of lack of motivation. Conclusion almost 7 in 10 children aged 12-23 months access vaccination at health facilities. There is evidence of parental apathy as well as misconceptions about vaccination.
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Affiliation(s)
- Fred Nsubuga
- Uganda National Expanded Program on Immunization, Ministry of Health, Kampala, Uganda
| | - Steven Ndugwa Kabwama
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Immaculate Ampeire
- Uganda National Expanded Program on Immunization, Ministry of Health, Kampala, Uganda
| | - Henry Luzze
- Uganda National Expanded Program on Immunization, Ministry of Health, Kampala, Uganda
| | - Pande Gerald
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Opar Bernard Toliva
- Uganda National Expanded Program on Immunization, Ministry of Health, Kampala, Uganda
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Atkinson KM, Wilson K, Murphy MSQ, El-Halabi S, Kahale LA, Laflamme LL, El-Khatib Z. Effectiveness of digital technologies at improving vaccine uptake and series completion - A systematic review and meta-analysis of randomized controlled trials. Vaccine 2019; 37:3050-3060. [PMID: 31036457 DOI: 10.1016/j.vaccine.2019.03.063] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 03/11/2019] [Accepted: 03/27/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Recent outbreaks and renewed concerns about immunization coverage call for new and effective interventions to improve vaccine uptake. Digital technologies have the potential to help address both suboptimal vaccine uptake and series completion. However, the effectiveness of pushing information and reminders to patients through digital technologies to address vaccination is not known. OBJECTIVE(S) The aim of this study is to determine if digital push interventions are effective in increasing vaccine uptake and series completion compared to non-digital interventions. METHODS We searched for RCTs where adults or parents of children were eligible for vaccination, the intervention was digital-push and the comparison group was non-digital. We included outcomes of vaccine uptake or series completion. We estimated summary effect sizes, heterogeneity using the χ2 test and quantified using the I2 statistic. Where heterogeneity remained significant, we conducted subgroup analyses. We assessed risk of bias, certainty of evidence and publication bias. RESULTS The search identified 159 peer-reviewed scientific publications. After review, a total of 12 manuscripts representing 13 empirical studies published between 2012 and 2016 were included. When comparing digital push interventions to non-digital ones, patients had 1.18[1.11,1.25] the odds of receiving vaccination or series completion compared to controls. In parents of children aged 18 and younger, those receiving digital push had a 1.22[1.15,1.30] increased odds compared to controls. Both analyses had high statistical heterogeneity, with I2 values of 86% and 79% respectively. The risk of bias was low with 10 of 13 studies considered low risk in five or more domains. The certainty of evidence for series completion was very low and for vaccine uptake was assessed to be moderate. CONCLUSION This study provides evidence that digital push technologies have a modest, positive impact on vaccine uptake and series completion compared to non-digital interventions.
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Affiliation(s)
- Katherine M Atkinson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Kumanan Wilson
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada; Department of Medicine, University of Ottawa, Ottawa, Canada.
| | - Malia S Q Murphy
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Soha El-Halabi
- Skoun Lebanese Addiction Center, Beirut, Lebanon; Department of Learning, Informatics, Management and Ethics, Karolinska Instituet, Stockholm, Sweden
| | - Lara A Kahale
- AUB GRADE Center, American University of Beirut, Lebanon
| | - Lucie L Laflamme
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Ziad El-Khatib
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; World Health Programme, Université du Québec en Abitibi-Témiscamingue (UQAT), Québec, Canada
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18
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Adamu AA, Uthman OA, Wambiya EO, Gadanya MA, Wiysonge CS. Application of quality improvement approaches in health-care settings to reduce missed opportunities for childhood vaccination: a scoping review. Hum Vaccin Immunother 2019; 15:2650-2659. [PMID: 30945976 DOI: 10.1080/21645515.2019.1600988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Missed opportunities for vaccination (MOV) is a poor reflection of the quality of care for children attending health facilities. It also contributes to a reduction in overall immunization coverage. Although there is a growing interest in the use of quality improvement (QI) in complex health systems to improve health outcomes, the degree to which this approach has been used to address MOV is poorly understood. We conducted a scoping review using Arksey and O'Malley's framework to investigate the extent to which QI has been used in health facilities to reduce MOV. The review followed five stages as follows: (1) identifying the research question; (2) identifying the relevant studies; (3) selecting the studies; (4) charting data; and (5) collating, summarizing, and reporting results. The search strategy included electronic databases and gray literature. A total of 12 literatures on QI projects focused on addressing MOV were identified. Eleven were published manuscripts, and one was a conference presentation. All the QI projects published were conducted in the United States and majority were between 2014 and 2018. In these projects, 45 change ideas targeting providers, clients, and health system were used. This study generated important evidence on the use of QI in health facilities to reduce MOV. In addition, the result suggests that there is a growing interest in the use of this approach to address MOV in recent years. However, no literature was found in low- and middle-income countries especially sub-Saharan Africa.
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Affiliation(s)
- Abdu A Adamu
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa.,Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Olalekan A Uthman
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, UK
| | - Elvis O Wambiya
- Education and Youth Empowerment Unit, African Population and Health Research Centre, Nairobi, Kenya
| | - Muktar A Gadanya
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa.,Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Abstract
This report covers the topics of pandemics, epidemics and partnerships, including regulatory convergence initiatives, new technologies and novel vaccines, discussed by leading public and private sector stakeholders at the 18th Annual General Meeting (AGM) of the Developing Countries Vaccine Manufacturers' Network (DCVMN). Contributions of Gavi and the vaccine industry from emerging countries to the growing global vaccine market, by improving the supply base from manufacturers in developing countries and contributing to 58% of doses, were highlighted. The Coalition for Epidemic Preparedness Innovations (CEPI), the International Vaccine Institute (IVI) and others reported on new strategies to ensure speedy progress in preclinical and clinical development of innovative vaccines for future MERS, Zika or other outbreak response. Priorities for vaccine stockpiling, to assure readiness during emergencies and to prevent outbreaks due to re-emerging diseases such as yellow fever, cholera and poliomyelitis, were outlined. The role of partnerships in improving global vaccine access, procurement and immunization coverage, and shared concerns were reviewed. The World Health Organization (WHO) and other international collaborating partners provided updates on the Product, Price and Procurement database, the prequalification of vaccines, the control of neglected tropical diseases, particularly the new rabies elimination initiative, and regulatory convergence proposals to accelerate vaccine registration in developing countries. Updates on supply chain innovations and novel vaccine platforms were presented. The discussions enabled members and partners to reflect on efficiency of research & development, supply chain tools and trends in packaging technologies improving delivery of existing vaccines, and allowing a deeper understanding of the current public-health objectives, industry financing, and global policies, required to ensure optimal investments, alignment and stability of vaccine supply in developing countries.
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Affiliation(s)
- Sonia Pagliusi
- DCVMN International, Route de Crassier 7, 1262 Nyon, Switzerland.
| | - Maureen Dennehy
- DCVMN International, Route de Crassier 7, 1262 Nyon, Switzerland.
| | - Hun Kim
- Vaccine Business Group, SK Chemicals, SK Chemicals Complex, 332, Pangyo-ro, Bundang-gu, Seongnam-si, 13493 Gyeonggi-do, South Korea.
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20
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Masters NB, Wagner AL, Carlson BF, Boulton ML. Vaccination timeliness and co-administration among Kenyan children. Vaccine 2018; 36:1353-1360. [PMID: 29429814 DOI: 10.1016/j.vaccine.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Timely administration of recommended vaccines requires children to have multiple vaccines co-administered in the first year of life. The objectives of this study were to estimate the proportion of timely vaccinations and the proportion of co-administered vaccines, and to assess the relationship between vaccine co-administration and vaccine timeliness in Kenyan children. METHODS Using the 2014 Kenyan Demographic and Health Survey (DHS), we calculated the proportion of children who received co-administered and timely vaccine doses. Co-administration was defined as doses administered on the same day with dates recorded on vaccination cards. Vaccines were considered timely if given within four days before to four weeks after the recommended interval for administration. RESULTS 10,385 children aged 1-4 years in the Kenyan 2014 DHS dataset had vaccination cards which comprised the study sample. Analysis revealed wide a range for receipt of timely doses, from 90.2% for OPV0 to 56.0% for Measles. Co-administration of the 6-week dose was associated with 2.81 times higher odds of a timely Penta dose 1 (95% CI: 2.28, 3.46) and birth-dose co-administration was associated with a substantial increase in timely BCG vaccination: AOR 7.43 (95% CI: 6.31, 8.75). CONCLUSIONS Though vaccine coverage in Kenya was high, timely vaccination was markedly low, with resultant implications for population immunity and potential spread of communicable diseases in unvaccinated infants. Co-administration of vaccines, place of residence, wealth index, and child age were consistently related to the odds of timely vaccine receipt. These relationships reinforce the importance of dedicating resources to programs that educate low socio-economic groups about the importance of vaccine co-administration.
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Affiliation(s)
- Nina B Masters
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Bradley F Carlson
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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21
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Riumallo-Herl C, Chang AY, Clark S, Constenla D, Clark A, Brenzel L, Verguet S. Poverty reduction and equity benefits of introducing or scaling up measles, rotavirus and pneumococcal vaccines in low-income and middle-income countries: a modelling study. BMJ Glob Health 2018; 3:e000613. [PMID: 29662691 PMCID: PMC5898318 DOI: 10.1136/bmjgh-2017-000613] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/19/2018] [Accepted: 02/24/2018] [Indexed: 12/22/2022] Open
Abstract
Introduction Beyond their impact on health, vaccines can lead to large economic benefits. While most economic evaluations of vaccines have focused on the health impact of vaccines at a national scale, it is critical to understand how their impact is distributed along population subgroups. Methods We build a financial risk protection model to evaluate the impact of immunisation against measles, severe pneumococcal disease and severe rotavirus for birth cohorts vaccinated over 2016-2030 for three scenarios in 41 Gavi-eligible countries: no immunisation, current immunisation coverage forecasts and the current immunisation coverage enhanced with funding support. We distribute modelled disease cases per socioeconomic group and derive the number of cases of: (1) catastrophic health costs (CHCs) and (2) medical impoverishment. Results In the absence of any vaccine coverage, the number of CHC cases attributable to measles, severe pneumococcal disease and severe rotavirus would be approximately 18.9 million, 6.6 million and 2.2 million, respectively. Expanding vaccine coverage would reduce this number by up to 90%, 30% and 40% in each case. More importantly, we find a higher share of CHC incidence among the poorest quintiles who consequently benefit more from vaccine expansion. Conclusion Our findings contribute to the understanding of how vaccines can have a broad economic impact. In particular, we find that immunisation programmes can reduce the proportion of households facing catastrophic payments from out-of-pocket health expenses, mainly in lower socioeconomic groups. Thus, vaccines could have an important role in poverty reduction.
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Affiliation(s)
- Carlos Riumallo-Herl
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Department of Applied Economics, Erasmus School of Economics, Erasmus University of Rotterdam, Rotterdam, The Netherlands
| | - Angela Y Chang
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Samantha Clark
- Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, Washington, USA
| | - Dagna Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew Clark
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Logan Brenzel
- Bill and Melinda Gates Foundation, Washington DC, USA
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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22
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Chang AY, Riumallo-Herl C, Perales NA, Clark S, Clark A, Constenla D, Garske T, Jackson ML, Jean K, Jit M, Jones EO, Li X, Suraratdecha C, Bullock O, Johnson H, Brenzel L, Verguet S. The Equity Impact Vaccines May Have On Averting Deaths And Medical Impoverishment In Developing Countries. Health Aff (Millwood) 2018; 37:316-324. [PMID: 29401021 DOI: 10.1377/hlthaff.2017.0861] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With social policies increasingly directed toward enhancing equity through health programs, it is important that methods for estimating the health and economic benefits of these programs by subpopulation be developed, to assess both equity concerns and the programs' total impact. We estimated the differential health impact (measured as the number of deaths averted) and household economic impact (measured as the number of cases of medical impoverishment averted) of ten antigens and their corresponding vaccines across income quintiles for forty-one low- and middle-income countries. Our analysis indicated that benefits across these vaccines would accrue predominantly in the lowest income quintiles. Policy makers should be informed about the large health and economic distributional impact that vaccines could have, and they should view vaccination policies as potentially important channels for improving health equity. Our results provide insight into the distribution of vaccine-preventable diseases and the health benefits associated with their prevention.
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Affiliation(s)
- Angela Y Chang
- Angela Y. Chang ( ) was a doctor of science candidate in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts, at the time this article was completed. Currently she is a postdoctoral fellow at the Institute for Health Metrics and Evaluation, University of Washington, in Seattle
| | - Carlos Riumallo-Herl
- Carlos Riumallo-Herl was a doctor of science candidate in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, at the time this article was completed. Currently he is a postdoctoral fellow in the Department of Applied Economics, Erasmus School of Economics, in Rotterdam, the Netherlands
| | - Nicole A Perales
- Nicole A. Perales was a master of science student in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, at the time this article was completed. Currently she is a doctoral student at the University of California, Berkeley
| | - Samantha Clark
- Samantha Clark is a PhD candidate in the Pharmaceutical Outcomes Research and Policy Program, University of Washington
| | - Andrew Clark
- Andrew Clark is an assistant professor in health decision modelling, London School of Hygiene and Tropical Medicine, in the United Kingdom
| | - Dagna Constenla
- Dagna Constenla is an associate scientist and the director of Economics and Finance in the Vaccine Access Center of the Department of International Health, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Tini Garske
- Tini Garske is a lecturer in the MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, in the United Kingdom
| | - Michael L Jackson
- Michael L. Jackson is an associate investigator at the Kaiser Permanente Washington Health Research Institute, in Seattle
| | - Kévin Jean
- Kévin Jean is a lecturer in epidemiology in the laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des Arts et Métiers, in Paris, France, and a visiting lecturer in the MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London
| | - Mark Jit
- Mark Jit is a professor of vaccine epidemiology in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine
| | - Edward O Jones
- Edward O. Jones was a researcher in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, when this article was completed
| | - Xi Li
- Xi Li is an independent health consultant in Manila, the Philippines
| | | | - Olivia Bullock
- Olivia Bullock is a program officer at Gavi, the Vaccine Alliance, in Geneva, Switzerland
| | - Hope Johnson
- Hope Johnson is director of monitoring and evaluation at Gavi, the Vaccine Alliance
| | - 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
| | - Stéphane Verguet
- Stéphane Verguet is an assistant professor of global health in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health
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23
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Ganguly E, Gupta R, Widge A, Reddy RP, Balasubramanian K, Reddy PS. Increasing Full Child Immunization Rates by Government Using an Innovative Computerized Immunization Due List in Rural India. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2018; 55:46958017751292. [PMID: 29359630 PMCID: PMC5798730 DOI: 10.1177/0046958017751292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Increasing child vaccination coverage to 85% or more in rural India from the current level of 50% holds great promise for reducing infant and child mortality and improving health of children. We have tested a novel strategy called Rural Effective Affordable Comprehensive Health Care (REACH) in a rural population of more than 300 000 in Rajasthan and succeeded in achieving full immunization coverage of 88.7% among children aged 12 to 23 months in a short span of less than 2 years. The REACH strategy was first developed and successfully implemented in a demonstration project by SHARE INDIA in Medchal region of Andhra Pradesh, and was then replicated in Rajgarh block of Rajasthan in cooperation with Bhoruka Charitable Trust (private partners of Integrated Child Development Services and National Rural Health Mission health workers in Rajgarh). The success of the REACH strategy in both Andhra Pradesh and Rajasthan suggests that it could be successfully adopted as a model to enhance vaccination coverage dramatically in other areas of rural India.
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Affiliation(s)
| | - Rahul Gupta
- 2 Bhoruka Charitable Trust, Rajasthan, India
| | - Alik Widge
- 3 University of Washington, Seattle, USA
| | | | | | - P S Reddy
- 1 SHARE INDIA, Ghanpur, India.,4 University of Pittsburgh, PA, USA
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24
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Tulchinsky TH. Maurice Hilleman: Creator of Vaccines That Changed the World. CASE STUDIES IN PUBLIC HEALTH 2018. [PMCID: PMC7150172 DOI: 10.1016/b978-0-12-804571-8.00003-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Maurice Ralph Hilleman (1919–2005) was one of the greatest microbiologists/vaccinologists of all time. He played a key role in developing vaccines for Asian flu in 1957 and Hong Kong flu in 1968. Over six decades, most of which were spent at Merck & Company, his leadership and innovations blazed new trails in virology, epidemiology, immunology, cancer research, and vaccine development that were unmatched. His work resulted in current vaccines used for the prevention of measles, mumps, hepatitis A and B, chickenpox, meningitis, and pneumonia, which have saved millions of lives across the globe. The need for close cooperation between public and private agencies, including donors, to promote research in vaccinology is reemphasized by recent global health crises such as the Ebola and Zika viruses, as well as the annual influenza virus threats. Eradication of many diseases is feasible, but requires political support for resources, vaccine development and harmonization of vaccination policies, to be achievable. Hilleman worked with many collaborators in academic centers, in industrial management, with which he led his research and development team to produce world-changing achievements.
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25
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Nnadi C, Etsano A, Uba B, Ohuabunwo C, Melton M, Wa Nganda G, Esapa L, Bolu O, Mahoney F, Vertefeuille J, Wiesen E, Durry E. Approaches to Vaccination Among Populations in Areas of Conflict. J Infect Dis 2017; 216:S368-S372. [PMID: 28838202 PMCID: PMC5754212 DOI: 10.1093/infdis/jix175] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Vaccination is an important and cost-effective disease prevention and control strategy. Despite progress in vaccine development and immunization delivery systems worldwide, populations in areas of conflict (hereafter, “conflict settings”) often have limited or no access to lifesaving vaccines, leaving them at increased risk for morbidity and mortality related to vaccine-preventable disease. Without developing and refining approaches to reach and vaccinate children and other vulnerable populations in conflict settings, outbreaks of vaccine-preventable disease in these settings may persist and spread across subnational and international borders. Understanding and refining current approaches to vaccinating populations in conflict and humanitarian emergency settings may save lives. Despite major setbacks, the Global Polio Eradication Initiative has made substantial progress in vaccinating millions of children worldwide, including those living in communities affected by conflicts and other humanitarian emergencies. In this article, we examine key strategic and operational tactics that have led to increased polio vaccination coverage among populations living in diverse conflict settings, including Nigeria, Somalia, and Pakistan, and how these could be applied to reach and vaccinate populations in other settings across the world.
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Affiliation(s)
- Chimeremma Nnadi
- Global Immunization Division, Centers for Disease Prevention and Control, Atlanta, Georgia
| | - Andrew Etsano
- Nigeria Polio Emergency Operations Center, National Primary Health Care Development Agency
| | - Belinda Uba
- National Stop Transmission of Polio Program, Africa Field Epidemiology and Training Network Nigeria Country Office, Abuja, Nigeria
| | - Chima Ohuabunwo
- Global Immunization Division, Centers for Disease Prevention and Control, Atlanta, Georgia
| | - Musa Melton
- National Stop Transmission of Polio Program, Africa Field Epidemiology and Training Network Nigeria Country Office, Abuja, Nigeria
| | - Gatei Wa Nganda
- Global Immunization Division, Centers for Disease Prevention and Control, Atlanta, Georgia
| | - Lisa Esapa
- Global Immunization Division, Centers for Disease Prevention and Control, Atlanta, Georgia
| | - Omotayo Bolu
- Global Immunization Division, Centers for Disease Prevention and Control, Atlanta, Georgia
| | - Frank Mahoney
- Global Immunization Division, Centers for Disease Prevention and Control, Atlanta, Georgia
| | - John Vertefeuille
- Global Immunization Division, Centers for Disease Prevention and Control, Atlanta, Georgia
| | - Eric Wiesen
- Global Immunization Division, Centers for Disease Prevention and Control, Atlanta, Georgia
| | - Elias Durry
- Global Immunization Division, Centers for Disease Prevention and Control, Atlanta, Georgia
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26
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Hayman DTS, Marshall JC, French NP, Carpenter TE, Roberts MG, Kiedrzynski T. Cost-benefit analyses of supplementary measles immunisation in the highly immunized population of New Zealand. Vaccine 2017; 35:4913-4922. [PMID: 28802754 DOI: 10.1016/j.vaccine.2017.07.077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/23/2017] [Accepted: 07/24/2017] [Indexed: 11/19/2022]
Abstract
As endemic measles is eliminated from countries through increased immunisation, the economic benefits of enhanced immunisation programs may come into question. New Zealand has suffered from outbreaks after measles introductions from abroad and we use it as a model system to understand the benefits of catch up immunisation in highly immunised populations. We provide cost-benefit analyses for measles supplementary immunisation in New Zealand. We model outbreaks based on estimates of the basic reproduction number in the vaccinated population (Rv, the number of secondary infections in a partially immunised population), based on the number of immunologically-naïve people at district and national levels, considering both pre- and post-catch up vaccination scenarios. Our analyses suggest that measles Rv often includes or exceeds one (0.18-3.92) despite high levels of population immunity. We calculate the cost of the first 187 confirmed and probable measles cases in 2014 to be over NZ$1 million (∼US$864,200) due to earnings lost, case management and hospitalization costs. The benefit-cost ratio analyses suggest additional vaccination beyond routine childhood immunisation is economically efficient. Supplemental vaccination-related costs are required to exceed approximately US$66 to US$1877 per person, depending on different scenarios, before supplemental vaccination is economically inefficient. Thus, our analysis suggests additional immunisation beyond childhood programs to target naïve individuals is economically beneficial even when childhood immunisation rates are high.
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Affiliation(s)
- D T S Hayman
- (m)EpiLab, Infectious Diseases Research Centre, Massey University, Palmerston North 4442, New Zealand.
| | - J C Marshall
- (m)EpiLab, Infectious Diseases Research Centre, Massey University, Palmerston North 4442, New Zealand
| | - N P French
- (m)EpiLab, Infectious Diseases Research Centre, Massey University, Palmerston North 4442, New Zealand
| | - T E Carpenter
- EpiCentre, Infectious Diseases Research Centre, Massey University, Palmerston North 4442, New Zealand
| | - M G Roberts
- Infectious Diseases Research Centre, Institute of Natural & Mathematical Sciences, New Zealand Institute for Advanced Study, Massey University, Private Bag 102 904, North Shore Mail Centre, Auckland, New Zealand
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27
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Ozawa S, Clark S, Portnoy A, Grewal S, Stack ML, Sinha A, Mirelman A, Franklin H, Friberg IK, Tam Y, Walker N, Clark A, Ferrari M, Suraratdecha C, Sweet S, Goldie SJ, Garske T, Li M, Hansen PM, Johnson HL, Walker D. Estimated economic impact of vaccinations in 73 low- and middle-income countries, 2001-2020. Bull World Health Organ 2017; 95:629-638. [PMID: 28867843 PMCID: PMC5578376 DOI: 10.2471/blt.16.178475] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 12/30/2022] Open
Abstract
Objective To estimate the economic impact likely to be achieved by efforts to vaccinate against 10 vaccine-preventable diseases between 2001 and 2020 in 73 low- and middle-income countries largely supported by Gavi, the Vaccine Alliance. Methods We used health impact models to estimate the economic impact of achieving forecasted coverages for vaccination against Haemophilus influenzae type b, hepatitis B, human papillomavirus, Japanese encephalitis, measles, Neisseria meningitidis serogroup A, rotavirus, rubella, Streptococcus pneumoniae and yellow fever. In comparison with no vaccination, we modelled the costs – expressed in 2010 United States dollars (US$) – of averted treatment, transportation costs, productivity losses of caregivers and productivity losses due to disability and death. We used the value-of-a-life-year method to estimate the broader economic and social value of living longer, in better health, as a result of immunization. Findings We estimated that, in the 73 countries, vaccinations given between 2001 and 2020 will avert over 20 million deaths and save US$ 350 billion in cost of illness. The deaths and disability prevented by vaccinations given during the two decades will result in estimated lifelong productivity gains totalling US$ 330 billion and US$ 9 billion, respectively. Over the lifetimes of the vaccinated cohorts, the same vaccinations will save an estimated US$ 5 billion in treatment costs. The broader economic and social value of these vaccinations is estimated at US$ 820 billion. Conclusion By preventing significant costs and potentially increasing economic productivity among some of the world’s poorest countries, the impact of immunization goes well beyond health.
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Affiliation(s)
- Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB # 7574, Beard Hall 115H, Chapel Hill, North Carolina, 27599, United States of America (USA)
| | - Samantha Clark
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Allison Portnoy
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, USA
| | - Simrun Grewal
- Department of Pharmacy, University of Washington, Seattle, USA
| | | | - Anushua Sinha
- Department of Preventive Medicine and Community Health, Rutgers New Jersey Medical School, Newark, USA
| | - Andrew Mirelman
- Centre for Health Economics, University of York, York, England
| | - Heather Franklin
- Department of Preventive Medicine and Community Health, Rutgers New Jersey Medical School, Newark, USA
| | - Ingrid K Friberg
- Department of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Yvonne Tam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Neff Walker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Andrew Clark
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, England
| | - Matthew Ferrari
- Center for Infectious Disease Dynamics, The Pennsylvania State University, University Park, USA
| | | | - Steven Sweet
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, USA
| | - Sue J Goldie
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, USA
| | - Tini Garske
- MRC Centre for Outbreak Analysis and Modelling, Imperial College London, London, England
| | - Michelle Li
- Gavi, the Vaccine Alliance, Geneva, Switzerland
| | - Peter M Hansen
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
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Gibson DG, Ochieng B, Kagucia EW, Were J, Hayford K, Moulton LH, Levine OS, Odhiambo F, O'Brien KL, Feikin DR. Mobile phone-delivered reminders and incentives to improve childhood immunisation coverage and timeliness in Kenya (M-SIMU): a cluster randomised controlled trial. Lancet Glob Health 2017; 5:e428-e438. [PMID: 28288747 PMCID: PMC5348605 DOI: 10.1016/s2214-109x(17)30072-4] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 01/13/2017] [Accepted: 01/13/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND As mobile phone access continues to expand globally, opportunities exist to leverage these technologies to support demand for immunisation services and improve vaccine coverage. We aimed to assess whether short message service (SMS) reminders and monetary incentives can improve immunisation uptake in Kenya. METHODS In this cluster-randomised controlled trial, villages were randomly and evenly allocated to four groups: control, SMS only, SMS plus a 75 Kenya Shilling (KES) incentive, and SMS plus 200 KES (85 KES = USD$1). Caregivers were eligible if they had a child younger than 5 weeks who had not yet received a first dose of pentavalent vaccine. Participants in the intervention groups received SMS reminders before scheduled pentavalent and measles immunisation visits. Participants in incentive groups, additionally, received money if their child was timely immunised (immunisation within 2 weeks of the due date). Caregivers and interviewers were not masked. The proportion of fully immunised children (receiving BCG, three doses of polio vaccine, three doses of pentavalent vaccine, and measles vaccine) by 12 months of age constituted the primary outcome and was analysed with log-binomial regression and General Estimating Equations to account for correlation within clusters. This trial is registered with ClinicalTrials.gov, number NCT01878435. FINDINGS Between Oct 14, 2013, and Oct 17, 2014, we enrolled 2018 caregivers and their infants from 152 villages into the following four groups: control (n=489), SMS only (n=476), SMS plus 75 KES (n=562), and SMS plus 200 KES (n=491). Overall, 1375 (86%) of 1600 children who were successfully followed up achieved the primary outcome, full immunisation by 12 months of age (296 [82%] of 360 control participants, 332 [86%] of 388 SMS only participants, 383 [86%] of 446 SMS plus 75 KES participants, and 364 [90%] of 406 SMS plus 200 KES participants). Children in the SMS plus 200 KES group were significantly more likely to achieve full immunisation at 12 months of age (relative risk 1·09, 95% CI 1·02-1·16, p=0·014) than children in the control group. INTERPRETATION In a setting with high baseline immunisation coverage levels, SMS reminders coupled with incentives significantly improved immunisation coverage and timeliness. Given that global immunisation coverage levels have stagnated around 85%, the use of incentives might be one option to reach the remaining 15%. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Dustin G Gibson
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Benard Ochieng
- Kenya Medical Research Institute/Centers for Disease Control and Prevention Public Health and Research Collaboration, Kisumu, Kenya
| | - E Wangeci Kagucia
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joyce Were
- Kenya Medical Research Institute/Centers for Disease Control and Prevention Public Health and Research Collaboration, Kisumu, Kenya
| | - Kyla Hayford
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lawrence H Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Orin S Levine
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frank Odhiambo
- Kenya Medical Research Institute/Centers for Disease Control and Prevention Public Health and Research Collaboration, Kisumu, Kenya
| | - Katherine L O'Brien
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Daniel R Feikin
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ozawa S, Clark S, Portnoy A, Grewal S, Brenzel L, Walker DG. Return On Investment From Childhood Immunization In Low- And Middle-Income Countries, 2011-20. Health Aff (Millwood) 2017; 35:199-207. [PMID: 26858370 DOI: 10.1377/hlthaff.2015.1086] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An analysis of return on investment can help policy makers support, optimize, and advocate for the expansion of immunization programs in the world's poorest countries. We assessed the return on investment associated with achieving projected coverage levels for vaccinations to prevent diseases related to ten antigens in ninety-four low- and middle-income countries during 2011-20, the Decade of Vaccines. We derived these estimates by using costs of vaccines, supply chains, and service delivery and their associated economic benefits. Based on the costs of illnesses averted, we estimated that projected immunizations will yield a net return about 16 times greater than costs over the decade (uncertainty range: 10-25). Using a full-income approach, which quantifies the value that people place on living longer and healthier lives, we found that net returns amounted to 44 times the costs (uncertainty range: 27-67). Across all antigens, net returns were greater than costs. But to realize the substantial positive return on investment from immunization programs, it is essential that governments and donors provide the requisite investments.
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Affiliation(s)
- Sachiko Ozawa
- Sachiko Ozawa is an assistant scientist in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Samantha Clark
- Samantha Clark is a research associate in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health
| | - Allison Portnoy
- Allison Portnoy is an SD candidate in the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, in Boston, Massachusetts
| | - Simrun Grewal
- Simrun Grewal is a PhD candidate in the Pharmaceutical Outcomes Research and Policy Program, University of Washington, in Seattle
| | - Logan Brenzel
- Logan Brenzel is a senior program officer for cost-effectiveness in vaccine delivery at the Bill & Melinda Gates Foundation in Washington, D.C
| | - Damian G Walker
- Damian G. Walker is a deputy director for data and analytics in global development at the Bill & Melinda Gates Foundation in Seattle
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30
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Rojo JU, Melkus MW, Kottapalli KR, Okiya OE, Sudduth J, Zhang W, Molehin AJ, Carter D, Siddiqui AA. Sm-p80-based schistosomiasis vaccine mediated epistatic interactions identified potential immune signatures for vaccine efficacy in mice and baboons. PLoS One 2017; 12:e0171677. [PMID: 28192534 PMCID: PMC5305113 DOI: 10.1371/journal.pone.0171677] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/23/2017] [Indexed: 12/22/2022] Open
Abstract
Schistosomiasis is a neglected parasitic disease of major public health concern as it affects over 250 million people in developing countries. Currently there is no licensed vaccine available against schistosomiasis. The Schistosoma mansoni calpain protein, Sm-p80, is a leading vaccine candidate now ready to move to clinical trials. In order to better assess Sm-p80 vaccine immunogenicity; here we used a systems biology approach employing RNA-sequencing to identify gene signatures and epistatic interactions following Sm-p80 vaccination in mouse and baboon models that may predict vaccine efficacy. Recombinant Sm-p80 + CpG-oligodeoxynucleotide (ODN) vaccine formulation induced both cellular and humoral immunity genes with a predominant TH1 response as well as TH2 and TH17 gene signatures. Early gene responses and gene-network interactions in mice immunized with rSm-p80 + ODN appear to be initiated through TLR4 signaling. CSF genes, S100A alarmin genes and TNFRSF genes appear to be a signature of vaccine immunogenicity/efficacy as identified by their participation in gene network interactions in both mice and baboons. These gene families may provide a basis for predicting desirable outcomes for vaccines against schistosomiasis leading to a better understanding of the immune system response to vaccination.
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Affiliation(s)
- Juan U. Rojo
- Center for Tropical Medicine and Infectious Diseases, Texas Tech University School of Medicine, Lubbock, Texas, United States of America
| | - Michael W. Melkus
- Center for Tropical Medicine and Infectious Diseases, Texas Tech University School of Medicine, Amarillo, Texas, United States of America
| | - Kameswara Rao Kottapalli
- Center for Biotechnology and Genomics. Texas Tech University, Lubbock, Texas, United States of America
| | - Oscar E. Okiya
- Center for Tropical Medicine and Infectious Diseases, Texas Tech University School of Medicine, Lubbock, Texas, United States of America
| | - Justin Sudduth
- Center for Tropical Medicine and Infectious Diseases, Texas Tech University School of Medicine, Lubbock, Texas, United States of America
| | - Weidong Zhang
- Center for Tropical Medicine and Infectious Diseases, Texas Tech University School of Medicine, Lubbock, Texas, United States of America
- Department of Internal Medicine. Texas Tech University School of Medicine, Lubbock Texas, United States of America
| | - Adebayo J. Molehin
- Center for Tropical Medicine and Infectious Diseases, Texas Tech University School of Medicine, Lubbock, Texas, United States of America
- Department of Internal Medicine. Texas Tech University School of Medicine, Lubbock Texas, United States of America
| | - Darrick Carter
- PAI Life Sciences, Seattle, Washington, United States of America
- Infectious Disease Research Institute, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Afzal A. Siddiqui
- Center for Tropical Medicine and Infectious Diseases, Texas Tech University School of Medicine, Lubbock, Texas, United States of America
- Department of Internal Medicine. Texas Tech University School of Medicine, Lubbock Texas, United States of America
- * E-mail:
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31
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Bloom DE, Brenzel L, Cadarette D, Sullivan J. Moving beyond traditional valuation of vaccination: Needs and opportunities. Vaccine 2016; 35 Suppl 1:A29-A35. [PMID: 28017436 DOI: 10.1016/j.vaccine.2016.12.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 12/06/2016] [Indexed: 01/21/2023]
Abstract
Economic evaluations of vaccination traditionally focus on a relatively narrow set of vaccine benefits, such as averted medical care costs among those who are immunized. In recent years, researchers have identified additional vaccination benefits that should be incorporated into economic evaluations in order to reflect vaccination's full value. Early efforts to estimate the magnitude of these broader benefits suggest that vaccination has been substantially undervalued, which has important implications for public and private vaccine policy and human health and welfare. More and better data will be required to advance this emerging line of research on the value of vaccination. The article discusses promising data sources and methods and research questions needing to be addressed.
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Affiliation(s)
- David E Bloom
- Harvard T.H. Chan School of Public Health, United States.
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Verguet S, Memirie ST, Norheim OF. Assessing the burden of medical impoverishment by cause: a systematic breakdown by disease in Ethiopia. BMC Med 2016; 14:164. [PMID: 27769296 PMCID: PMC5075208 DOI: 10.1186/s12916-016-0697-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/16/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Out-of-pocket (OOP) medical expenses often lead to catastrophic expenditure and impoverishment in low- and middle-income countries. Yet, there has been no systematic examination of which specific diseases and conditions (e.g., tuberculosis, cardiovascular disease) drive medical impoverishment, defined as OOP direct medical costs pushing households into poverty. METHODS We used a cost and epidemiological model to propose an assessment of the burden of medical impoverishment in Ethiopia, i.e., the number of households crossing a poverty line due to excessive OOP direct medical expenses. We utilized disease-specific mortality estimates from the Global Burden of Disease study, epidemiological and cost inputs from surveys, and secondary data from the literature to produce a count of poverty cases due to OOP direct medical costs per specific condition. RESULTS In Ethiopia, in 2013, and among 20 leading causes of mortality, we estimated the burden of impoverishment due to OOP direct medical costs to be of about 350,000 poverty cases. The top three causes of medical impoverishment were diarrhea, lower respiratory infections, and road injury, accounting for 75 % of all poverty cases. CONCLUSIONS We present a preliminary attempt for the estimation of the burden of medical impoverishment by cause for high mortality conditions. In Ethiopia, medical impoverishment was notably associated with illness occurrence and health services utilization. Although currently used estimates are sensitive to health services utilization, a systematic breakdown of impoverishment due to OOP direct medical costs by cause can provide important information for the promotion of financial risk protection and equity, and subsequent design of health policies toward universal health coverage, reduction of direct OOP payments, and poverty alleviation.
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Affiliation(s)
- Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
| | | | - Ole Frithjof Norheim
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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33
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Ethgen O, Cornier M, Chriv E, Baron-Papillon F. The cost of vaccination throughout life: A western European overview. Hum Vaccin Immunother 2016; 12:2029-2037. [PMID: 27050111 PMCID: PMC4994732 DOI: 10.1080/21645515.2016.1154649] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/27/2016] [Accepted: 02/11/2016] [Indexed: 12/23/2022] Open
Abstract
Despite the interest of policy makers, the actual investment in vaccination is poorly documented. Our study assessed the costs of vaccination throughout life for a fully immunized Western European citizen. National vaccination calendars for England, France, Germany, Italy, Portugal, Spain and Sweden were retrieved. We differentiated men from women and healthy individuals from those suffering from underlying conditions who require specific additional vaccinations. Vaccine costs and administration fees were retrieved from official national source and calculated from the national healthcare perspective. Vaccinating an individual against up to 17 diseases throughout his entire life and in full compliance with national vaccination calendars cost between €328 and €2,352 (vaccines costs only) and between €443 and €3,395 (administration costs included), the lowest range corresponds to a healthy man in Sweden and the highest to a woman with underlying conditions in England. Vaccination costs varied among countries due to heterogeneous national vaccination calendars and organization. In all countries, adults (18-64 y) and elderly (≥65 y) accounted for the lowest vaccines costs compared with infants (0-24 m) and children/adolescents (2-17 y). In comparison, other mass secondary preventive therapies may be at least 3 times more costly. Vaccination requires a relatively low level of investment per individual. Our estimates should be considered to be the maximum potential costs due to our 100% compliance assumption. Increasing coverage rates would bring additional public health benefits for a relatively low incremental cost. A life-course approach of vaccination should also be encouraged because some missed opportunities remain in senior vaccinations.
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Affiliation(s)
- Olivier Ethgen
- Department of Public Health Sciences, Faculty of Medicine, University of Liège, Liège, Belgium, and SERFAN Innovation, Namur, Belgium
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34
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Thompson KM, Duintjer Tebbens RJ. Framework for Optimal Global Vaccine Stockpile Design for Vaccine-Preventable Diseases: Application to Measles and Cholera Vaccines as Contrasting Examples. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2016; 36:1487-1509. [PMID: 25109229 DOI: 10.1111/risa.12265] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Managing the dynamics of vaccine supply and demand represents a significant challenge with very high stakes. Insufficient vaccine supplies can necessitate rationing, lead to preventable adverse health outcomes, delay the achievements of elimination or eradication goals, and/or pose reputation risks for public health authorities and/or manufacturers. This article explores the dynamics of global vaccine supply and demand to consider the opportunities to develop and maintain optimal global vaccine stockpiles for universal vaccines, characterized by large global demand (for which we use measles vaccines as an example), and nonuniversal (including new and niche) vaccines (for which we use oral cholera vaccine as an example). We contrast our approach with other vaccine stockpile optimization frameworks previously developed for the United States pediatric vaccine stockpile to address disruptions in supply and global emergency response vaccine stockpiles to provide on-demand vaccines for use in outbreaks. For measles vaccine, we explore the complexity that arises due to different formulations and presentations of vaccines, consideration of rubella, and the context of regional elimination goals. We conclude that global health policy leaders and stakeholders should procure and maintain appropriate global vaccine rotating stocks for measles and rubella vaccine now to support current regional elimination goals, and should probably also do so for other vaccines to help prevent and control endemic or epidemic diseases. This work suggests the need to better model global vaccine supplies to improve efficiency in the vaccine supply chain, ensure adequate supplies to support elimination and eradication initiatives, and support progress toward the goals of the Global Vaccine Action Plan.
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Affiliation(s)
- Kimberly M Thompson
- Kid Risk, Inc, 10524 Moss Park Rd., Ste. 204-364, Orlando, FL, USA
- University of Central Florida, College of Medicine, Orlando, FL, USA
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35
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Mirelman AJ, Ozawa S, Grewal S. The economic and social benefits of childhood vaccinations in BRICS. Bull World Health Organ 2016; 92:454-6. [PMID: 24940021 DOI: 10.2471/blt.13.132597] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 03/14/2014] [Accepted: 03/19/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Andrew J Mirelman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E8132, Baltimore, Maryland, 21205, United States of America
| | - Sachiko Ozawa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E8132, Baltimore, Maryland, 21205, United States of America
| | - Simrun Grewal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E8132, Baltimore, Maryland, 21205, United States of America
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36
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Bloom DE. Valuing vaccines: deficiencies and remedies. Vaccine 2016; 33 Suppl 2:B29-33. [PMID: 26022563 DOI: 10.1016/j.vaccine.2015.03.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 03/05/2015] [Indexed: 11/25/2022]
Abstract
Current evaluation models for the value of vaccines typically account for a small subset of the full social and economic benefits of vaccination. Health investments yield positive economic benefits via several channels at the household, community, and national levels. Underestimating, or worse, not considering these benefits can lead to ill-founded recommendations regarding the introduction of vaccines into immunization programs. The clear and strong links between health and wealth suggest the need to redesign valuation frameworks for vaccination so that the full costs may be properly weighed against the full benefits of vaccines.
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Affiliation(s)
- David E Bloom
- Clarence James Gamble Professor of Economics and Demography, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1 12th Floor, Suite 1202 Boston, MA 02115, United States.
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37
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Hwang TJ, Kesselheim AS. Vaccine Pipeline Has Grown During The Past Two Decades With More Early-Stage Trials From Small And Medium-Size Companies. Health Aff (Millwood) 2016; 35:219-26. [DOI: 10.1377/hlthaff.2015.1073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Thomas J. Hwang
- Thomas J. Hwang is a venture capitalist at Bain Capital, in Boston, Massachusetts
| | - Aaron S. Kesselheim
- Aaron S. Kesselheim (
) is an associate professor of medicine at Harvard Medical School, in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital, in Boston
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Portnoy A, Jit M, Lauer J, Blommaert A, Ozawa S, Stack M, Murray J, Hutubessy R. Estimating costs of care for meningitis infections in low- and middle-income countries. Vaccine 2016; 33 Suppl 1:A240-7. [PMID: 25919168 DOI: 10.1016/j.vaccine.2014.11.061] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/22/2014] [Accepted: 11/18/2014] [Indexed: 11/24/2022]
Abstract
Meningitis infections are often associated with high mortality and risk of sequelae. The costs of treatment and care for meningitis are a great burden on health care systems, particularly in resource-limited settings. The objective of this study is to review data on the costs of care for meningitis in low- and middle-income countries, as well as to show how results could be extrapolated to countries without sound data. We conducted a systematic review of the literature from six databases to identify studies examining the cost of care in low- and middle-income countries for all age groups with suspected, probable, or confirmed meningitis. We extracted data on treatment costs and sequelae by infectious agent and/or pathogen, where possible. Using multiple regression analysis, a relationship between hospital costs and associated determinants was investigated in order to predict costs in countries with missing data. This relationship was used to predict treatment costs for all 144 low- and middle-income countries. The methodology of conducting a systematic review, extrapolating, and setting up a standard database can be used as a tool to inform cost-effectiveness analyses in situations where cost of care data are poor. Both acute and long-term costs of meningitis could be extrapolated to countries without reliable data. Although only bacterial causes of meningitis can be vaccine-preventable, a better understanding of the treatment costs for meningitis is crucial for low- and middle-income countries to assess the cost-effectiveness of proposed interventions in their country. This cost information will be important as inputs in future cost-effectiveness studies, particularly for vaccines.
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Affiliation(s)
- Allison Portnoy
- International Vaccine Access Center, Department of International Health, Johns Hopkins School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, MD, USA.
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; Modelling and Economics Unit, Public Health England, London NW9 5EQ, United Kingdom.
| | - Jeremy Lauer
- World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
| | - Adriaan Blommaert
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, Campus Drie Eiken Lokaal D.R.212, 2610 Wilrijk, Antwerp, Belgium; Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Hasselt University, Campus Diepenbeek Agoralaan Gebouw D; BE 3590, Diepenbeek, Belgium.
| | - Sachiko Ozawa
- International Vaccine Access Center, Department of International Health, Johns Hopkins School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, MD, USA.
| | - Meghan Stack
- Independent Consultant, 2417 Panama Street, Philadelphia, PA 19103, USA.
| | - Jillian Murray
- International Vaccine Access Center, Department of International Health, Johns Hopkins School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, MD, USA.
| | - Raymond Hutubessy
- World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
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Johansson KA, Memirie ST, Pecenka C, Jamison DT, Verguet S. Health Gains and Financial Protection from Pneumococcal Vaccination and Pneumonia Treatment in Ethiopia: Results from an Extended Cost-Effectiveness Analysis. PLoS One 2015; 10:e0142691. [PMID: 26650078 PMCID: PMC4674114 DOI: 10.1371/journal.pone.0142691] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 10/26/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Pneumonia and pneumococcal disease cause a large disease burden in resource-constrained settings. We pursue an extended cost-effectiveness analysis (ECEA) of two fully publicly financed interventions in Ethiopia: pneumococcal vaccination for newborns and pneumonia treatment for under-five children in Ethiopia. METHODS We apply ECEA methods and estimate the program impact on: (1) government program costs; (2) pneumonia and pneumococcal deaths averted; (3) household expenses related to pneumonia/pneumococcal disease treatment averted; (4) prevention of household medical impoverishment measured by an imputed money-metric value of financial risk protection; and (5) distributional consequences across the wealth strata of the country population. Available epidemiological and cost data from Ethiopia are applied and the two interventions are assessed separately at various incremental coverage levels. RESULTS Scaling-up pneumococcal vaccines at around 40% coverage would cost about $11.5 million and avert about 2090 child deaths annually, while a 10% increase of pneumonia treatment to all children under 5 years of age would cost about $13.9 million and avert 2610 deaths annually. Health benefits of the two interventions publicly financed would be concentrated among the bottom income quintile, where 30-40% of all deaths averted would be expected to occur in the poorest quintile. In sum, the two interventions would eliminate a total of $2.4 million of private household expenditures annually, where the richest quintile benefits from around 30% of the total private expenditures averted. The financial risk protection benefits would be largely concentrated among the bottom income quintile. The results are most sensitive to variations in vaccine price, population size, number of deaths due to pneumonia, efficacy of interventions and out-of-pocket copayment share. CONCLUSIONS Vaccine and treatment interventions for children, as shown with the illustrative examples of pneumococcal vaccine and pneumonia treatment, can bring large health and financial benefits to households in Ethiopia, most particularly among the poorest socio-economic groups.
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Affiliation(s)
- Kjell Arne Johansson
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | | | - Dean T. Jamison
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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McGovern ME, Canning D. Vaccination and all-cause child mortality from 1985 to 2011: global evidence from the Demographic and Health Surveys. Am J Epidemiol 2015; 182:791-8. [PMID: 26453618 PMCID: PMC4757942 DOI: 10.1093/aje/kwv125] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 03/04/2015] [Indexed: 01/13/2023] Open
Abstract
Based on models with calibrated parameters for infection, case fatality rates, and vaccine efficacy, basic childhood vaccinations have been estimated to be highly cost effective. We estimated the association of vaccination with mortality directly from survey data. Using 149 cross-sectional Demographic and Health Surveys, we determined the relationship between vaccination coverage and the probability of dying between birth and 5 years of age at the survey cluster level. Our data included approximately 1 million children in 68,490 clusters from 62 countries. We considered the childhood measles, bacillus Calmette-Guérin, diphtheria-pertussis-tetanus, polio, and maternal tetanus vaccinations. Using modified Poisson regression to estimate the relative risk of child mortality in each cluster, we also adjusted for selection bias that resulted from the vaccination status of dead children not being reported. Childhood vaccination, and in particular measles and tetanus vaccination, is associated with substantial reductions in childhood mortality. We estimated that children in clusters with complete vaccination coverage have a relative risk of mortality that is 0.73 (95% confidence interval: 0.68, 0.77) times that of children in a cluster with no vaccinations. Although widely used, basic vaccines still have coverage rates well below 100% in many countries, and our results emphasize the effectiveness of increasing coverage rates in order to reduce child mortality.
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Affiliation(s)
- Mark E. McGovern
- Correspondence to Dr. Mark E. McGovern, Queen's University Belfast, Riddel Hall, 185 Stranmillis Road, Belfast BT9 5EE, Northern Ireland (e-mail: )
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Landscaping the structures of GAVI country vaccine supply chains and testing the effects of radical redesign. Vaccine 2015. [DOI: 10.1016/j.vaccine.2015.07.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Driessen J, Olson ZD, Jamison DT, Verguet S. Comparing the health and social protection effects of measles vaccination strategies in Ethiopia: An extended cost-effectiveness analysis. Soc Sci Med 2015; 139:115-22. [DOI: 10.1016/j.socscimed.2015.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pecenka CJ, Johansson KA, Memirie ST, Jamison DT, Verguet S. Health gains and financial risk protection: an extended cost-effectiveness analysis of treatment and prevention of diarrhoea in Ethiopia. BMJ Open 2015; 5:e006402. [PMID: 25941175 PMCID: PMC4420944 DOI: 10.1136/bmjopen-2014-006402] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 03/20/2015] [Accepted: 03/25/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Policymakers face many decisions when considering public financing for health, including the kind of health interventions to include in a publically financed package. The consequences of these choices will influence health outcomes as well as the financial risk protection provided to different segments of the population. The purpose of this study is to illustrate the size and distribution of benefits due to treatment and prevention of diarrhoea (ie, rotavirus vaccination). METHODS We use an economic model to examine the impacts of universal public finance (UPF) of diarrhoeal treatment alone, as opposed to diarrhoeal treatment along with rotavirus vaccination in Ethiopia using extended cost-effectiveness analysis (ECEA). ECEA allows us to measure the health gains and financial risk protection provided by these interventions for each wealth quintile. Our model compares a baseline situation with diarrhoeal treatment seeking of 32% (overall) and no rotavirus vaccination, to a situation where UPF increases treatment seeking by 20 percentage points for each quintile and rotavirus vaccination reaches DTP (diphteria, pertussis, tetanus) 2 levels for each quintile (overall rate of 52%). We calculate deaths averted, private expenditures averted and costs incurred by the government under the baseline situation and with UPF. RESULTS We find that diarrhoeal treatment paired with rotavirus vaccination is more cost effective than diarrhoeal treatment alone for the metrics we examine in this paper (deaths and private expenditures averted). Per US$1 million invested, diarrhoeal treatment saves 44 lives and averts US$115,000 in private expenditures. For the same investment, diarrhoeal treatment and rotavirus vaccination save 61 lives and avert US$150,000 in private expenditures. The health benefits of these interventions tend to benefit the poor, while the financial benefits favour the better-off. CONCLUSIONS Policymakers should consider multiple benefit streams as well as their scale and incidence when considering public finance of health interventions.
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Affiliation(s)
| | - Kjell Arne Johansson
- The Department of Global Public Health and Primary Care, The University of Bergen, Bergen, Norway
| | - Solomon Tessema Memirie
- The Department of Global Public Health and Primary Care, The University of Bergen, Bergen, Norway
| | - Dean T Jamison
- Department of Global Health, The University of Washington, Seattle, USA
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, USA
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Verguet S, Olson ZD, Babigumira JB, Desalegn D, Johansson KA, Kruk ME, Levin CE, Nugent RA, Pecenka C, Shrime MG, Memirie ST, Watkins DA, Jamison DT. Health gains and financial risk protection afforded by public financing of selected interventions in Ethiopia: an extended cost-effectiveness analysis. LANCET GLOBAL HEALTH 2015; 3:e288-96. [DOI: 10.1016/s2214-109x(14)70346-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Anekwe TD, Newell ML, Tanser F, Pillay D, Bärnighausen T. The causal effect of childhood measles vaccination on educational attainment: A mother fixed-effects study in rural South Africa. Vaccine 2015; 33:5020-6. [PMID: 25936663 PMCID: PMC4570928 DOI: 10.1016/j.vaccine.2015.04.072] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 04/13/2015] [Accepted: 04/20/2015] [Indexed: 02/04/2023]
Abstract
Background Because measles vaccination prevents acute measles disease and morbidities secondary to measles, such as undernutrition, blindness, and brain damage, the vaccination may also lead to higher educational attainment. However, there has been little evidence to support this hypothesis at the population level. In this study, we estimate the causal effect of childhood measles vaccination on educational attainment among children born between 1995 and 2000 in South Africa. Methods and findings We use longitudinal data on measles vaccination status and school grade attainment among 4783 children. The data were collected by the Wellcome Trust Africa Centre Demographic Information System (ACDIS), which is one of Africa's largest health and demographic surveillance systems. ACDIS is located in a poor, predominantly rural, Zulu-speaking community in KwaZulu-Natal, South Africa. Using mother fixed-effects regression, we compare the school grade attainment of siblings who are discordant in their measles vaccination status but share the same mother and household. This fixed-effects approach controls for confounding due to both observed and unobserved factors that do not vary between siblings, including sibling-invariant mother and household characteristics such as attitudes toward risk, conscientiousness, and aspirations for children. We further control for a range of potential confounders that vary between siblings, such as sex of the child, year of birth, mother's age at child's birth, and birth order. We find that measles vaccination on average increases school grade attainment by 0.188 grades (95% confidence interval, 0.0424–0.334; p = 0.011). Conclusions Measles vaccination increased educational attainment in this poor, largely rural community in South Africa. For every five to seven children vaccinated against measles, one additional school grade was gained. The presence of a measles vaccination effect in this community is plausible because (i) measles vaccination prevents measles complications including blindness, brain damage, and undernutrition; (ii) a large number of number of children were at risk of contracting measles because of the comparatively low measles vaccination coverage; and (iii) significant measles transmission occurred in the community where this study took place during the study observation period. Our results demonstrate for the first time that measles vaccination affects human development not only through its health effects but also through its effects on education.
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Affiliation(s)
- Tobenna D Anekwe
- USDA Economic Research Service, Washington, DC 20224, USA; Wellcome Trust Africa Centre for Health and Population Studies, Mtubatuba 3935, South Africa.
| | - Marie-Louise Newell
- Wellcome Trust Africa Centre for Health and Population Studies, Mtubatuba 3935, South Africa; University of Southampton, Southampton SO17 1BJ, UK
| | - Frank Tanser
- Wellcome Trust Africa Centre for Health and Population Studies, Mtubatuba 3935, South Africa
| | - Deenan Pillay
- Wellcome Trust Africa Centre for Health and Population Studies, Mtubatuba 3935, South Africa; University College London, London WC1E 6BT, UK
| | - Till Bärnighausen
- Wellcome Trust Africa Centre for Health and Population Studies, Mtubatuba 3935, South Africa; Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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Abstract
Vaccination has led to remarkable health gains over the last century. However, large coverage gaps remain, which will require significant financial resources and political will to address. In recent years, a compelling line of inquiry has established the economic benefits of health, at both the individual and aggregate levels. Most existing economic evaluations of particular health interventions fail to account for this new research, leading to potentially sizable undervaluation of those interventions. In line with this new research, we set forth a framework for conceptualizing the full benefits of vaccination, including avoided medical care costs, outcome-related productivity gains, behavior-related productivity gains, community health externalities, community economic externalities, and the value of risk reduction and pure health gains. We also review literature highlighting the magnitude of these sources of benefit for different vaccinations. Finally, we outline the steps that need to be taken to implement a broad-approach economic evaluation and discuss the implications of this work for research, policy, and resource allocation for vaccine development and delivery.
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Affiliation(s)
- Till Bärnighausen
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02115; and Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba 3935, South Africa
| | - David E Bloom
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02115; and
| | | | - Jennifer Carroll O'Brien
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02115; and
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Kraan H, Vrieling H, Czerkinsky C, Jiskoot W, Kersten G, Amorij JP. Buccal and sublingual vaccine delivery. J Control Release 2014; 190:580-92. [PMID: 24911355 PMCID: PMC7114675 DOI: 10.1016/j.jconrel.2014.05.060] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/28/2014] [Accepted: 05/29/2014] [Indexed: 11/25/2022]
Abstract
Because of their large surface area and immunological competence, mucosal tissues are attractive administration and target sites for vaccination. An important characteristic of mucosal vaccination is its ability to elicit local immune responses, which act against infection at the site of pathogen entry. However, mucosal surfaces are endowed with potent and sophisticated tolerance mechanisms to prevent the immune system from overreacting to the many environmental antigens. Hence, mucosal vaccination may suppress the immune system instead of induce a protective immune response. Therefore, mucosal adjuvants and/or special antigen delivery systems as well as appropriate dosage forms are required in order to develop potent mucosal vaccines. Whereas oral, nasal and pulmonary vaccine delivery strategies have been described extensively, the sublingual and buccal routes have received considerably less attention. In this review, the characteristics of and approaches for sublingual and buccal vaccine delivery are described and compared with other mucosal vaccine delivery sites. We discuss recent progress and highlight promising developments in the search for vaccine formulations, including adjuvants and suitable dosage forms, which are likely critical for designing a successful sublingual or buccal vaccine. Finally, we outline the challenges, hurdles to overcome and formulation issues relevant for sublingual or buccal vaccine delivery.
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Affiliation(s)
- Heleen Kraan
- Intravacc (Institute for Translational Vaccinology), Bilthoven, The Netherlands.
| | - Hilde Vrieling
- Division of Drug Delivery Technology, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Leiden, The Netherlands
| | - Cecil Czerkinsky
- Institut de Pharmacologie Moleculaire et Cellulaire, UMR 7275 CNRS-INSERM-UNSA, Valbonne, France
| | - Wim Jiskoot
- Division of Drug Delivery Technology, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Leiden, The Netherlands
| | - Gideon Kersten
- Intravacc (Institute for Translational Vaccinology), Bilthoven, The Netherlands; Division of Drug Delivery Technology, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Leiden, The Netherlands
| | - Jean-Pierre Amorij
- Intravacc (Institute for Translational Vaccinology), Bilthoven, The Netherlands.
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Rheingans R, Amaya M, Anderson JD, Chakraborty P, Atem J. Systematic review of the economic value of diarrheal vaccines. Hum Vaccin Immunother 2014; 10:1582-94. [PMID: 24861846 PMCID: PMC5396238 DOI: 10.4161/hv.29352] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 05/24/2014] [Indexed: 01/23/2023] Open
Abstract
Diarrheal disease is a leading cause of child mortality in low-income settings and morbidity across a range of settings. A growing number of studies have addressed the economic value of new and emerging vaccines to reduce this threat. We conducted a systematic review to assess the economic value of diarrheal vaccines targeting a range of pathogens in different settings. The majority of studies focused on the economic value of rotavirus vaccines in different settings, with most of these concluding that vaccination would provide significant economic benefits across a range of vaccine prices. There is also evidence of the economic benefits of cholera vaccines in specific contexts. For other potential diarrheal vaccines data are limited and often hypothetical. Across all target pathogens and contexts, the evidence of economic value focuses the short-term health and economic gains. Additional information is needed on the broader social and long-term economic value of diarrhea vaccines.
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Affiliation(s)
- Richard Rheingans
- Department of Environmental and Global Health; Emerging Pathogens Institute; University of Florida; Gainesville, FL USA
- Department of Health Services Research, Management & Policy; College of Public Health and Health Professions; University of Florida; Gainesville, FL USA
| | - Mirna Amaya
- Department of Health Services Research, Management & Policy; College of Public Health and Health Professions; University of Florida; Gainesville, FL USA
| | - John D Anderson
- Department of Environmental and Global Health; Emerging Pathogens Institute; University of Florida; Gainesville, FL USA
| | - Poulomy Chakraborty
- Department of Environmental and Global Health; Emerging Pathogens Institute; University of Florida; Gainesville, FL USA
| | - Jacob Atem
- Department of Environmental and Global Health; Emerging Pathogens Institute; University of Florida; Gainesville, FL USA
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Enabling implementation of the Global Vaccine Action Plan: developing investment cases to achieve targets for measles and rubella prevention. Vaccine 2014; 31 Suppl 2:B149-56. [PMID: 23598476 DOI: 10.1016/j.vaccine.2012.11.091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 11/08/2012] [Accepted: 11/30/2012] [Indexed: 11/22/2022]
Abstract
Global prevention and control of infectious diseases requires significant investment of financial and human resources and well-functioning leadership and management structures. The reality of competing demands for limited resources leads to trade-offs and questions about the relative value of specific investments. Developing investment cases can help to provide stakeholders with information about the benefits, costs, and risks associated with available options, including examination of social, political, governance, and ethical issues. We describe the process of developing investment cases for globally coordinated management of action plans for measles and rubella as tools for enabling the implementation of the Global Vaccine Action Plan (GVAP). We focus on considerations related to the timing of efforts to achieve measles and rubella goals independently and within the context of ongoing polio eradication efforts, other immunization priorities, and other efforts to control communicable diseases or child survival initiatives. Our analysis suggests that the interactions between the availability and sustainability of financial support, sufficient supplies of vaccines, capacity of vaccine delivery systems, and commitments at all levels will impact the feasibility and timing of achieving national, regional, and global goals. The timing of investments and achievements will determine the net financial and health benefits obtained. The methodology, framing, and assumptions used to characterize net benefits and uncertainties in the investment cases will impact estimates and perceptions about the value of prevention achieved overall by the GVAP. We suggest that appropriately valuing the benefits of investments of measles and rubella prevention will require the use of integrated dynamic disease, economic, risk, and decision analytic models in combination with consideration of qualitative factors, and that synthesizing information in the form of investment cases may help stakeholders manage expectations as they chart the course ahead and navigate the decade of vaccines.
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Chen SI, Norman BA, Rajgopal J, Assi TM, Lee BY, Brown ST. A planning model for the WHO-EPI vaccine distribution network in developing countries. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/0740817x.2013.813094] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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