Assessing the impacts of COVID-19 vaccination programme’s timing and speed on health benefits, cost-effectiveness, and relative affordability in 27 African countries
Abstract Background The COVID-19 vaccine supply shortage in 2021 constrained roll-out efforts in Africa while populations experienced waves of epidemics. As supply improves, a key question is whether vaccination remains an impactful and cost-effective strategy given changes in the timing of implemen...
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | BMC Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12916-023-02784-z |
| _version_ | 1827983859841499136 |
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| author | Yang Liu Simon R. Procter Carl A. B. Pearson Andrés Madriz Montero Sergio Torres-Rueda Elias Asfaw Benjamin Uzochukwu Tom Drake Eleanor Bergren Rosalind M. Eggo Francis Ruiz Nicaise Ndembi Justice Nonvignon Mark Jit Anna Vassall |
| author_facet | Yang Liu Simon R. Procter Carl A. B. Pearson Andrés Madriz Montero Sergio Torres-Rueda Elias Asfaw Benjamin Uzochukwu Tom Drake Eleanor Bergren Rosalind M. Eggo Francis Ruiz Nicaise Ndembi Justice Nonvignon Mark Jit Anna Vassall |
| author_sort | Yang Liu |
| collection | DOAJ |
| description | Abstract Background The COVID-19 vaccine supply shortage in 2021 constrained roll-out efforts in Africa while populations experienced waves of epidemics. As supply improves, a key question is whether vaccination remains an impactful and cost-effective strategy given changes in the timing of implementation. Methods We assessed the impact of vaccination programme timing using an epidemiological and economic model. We fitted an age-specific dynamic transmission model to reported COVID-19 deaths in 27 African countries to approximate existing immunity resulting from infection before substantial vaccine roll-out. We then projected health outcomes (from symptomatic cases to overall disability-adjusted life years (DALYs) averted) for different programme start dates (01 January to 01 December 2021, n = 12) and roll-out rates (slow, medium, fast; 275, 826, and 2066 doses/million population-day, respectively) for viral vector and mRNA vaccines by the end of 2022. Roll-out rates used were derived from observed uptake trajectories in this region. Vaccination programmes were assumed to prioritise those above 60 years before other adults. We collected data on vaccine delivery costs, calculated incremental cost-effectiveness ratios (ICERs) compared to no vaccine use, and compared these ICERs to GDP per capita. We additionally calculated a relative affordability measure of vaccination programmes to assess potential nonmarginal budget impacts. Results Vaccination programmes with early start dates yielded the most health benefits and lowest ICERs compared to those with late starts. While producing the most health benefits, fast vaccine roll-out did not always result in the lowest ICERs. The highest marginal effectiveness within vaccination programmes was found among older adults. High country income groups, high proportions of populations over 60 years or non-susceptible at the start of vaccination programmes are associated with low ICERs relative to GDP per capita. Most vaccination programmes with small ICERs relative to GDP per capita were also relatively affordable. Conclusion Although ICERs increased significantly as vaccination programmes were delayed, programmes starting late in 2021 may still generate low ICERs and manageable affordability measures. Looking forward, lower vaccine purchasing costs and vaccines with improved efficacies can help increase the economic value of COVID-19 vaccination programmes. |
| first_indexed | 2024-04-09T22:52:48Z |
| format | Article |
| id | doaj.art-5b105e052d524722b00c748dbb262671 |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-04-09T22:52:48Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-5b105e052d524722b00c748dbb2626712023-03-22T11:32:30ZengBMCBMC Medicine1741-70152023-03-0121111510.1186/s12916-023-02784-zAssessing the impacts of COVID-19 vaccination programme’s timing and speed on health benefits, cost-effectiveness, and relative affordability in 27 African countriesYang Liu0Simon R. Procter1Carl A. B. Pearson2Andrés Madriz Montero3Sergio Torres-Rueda4Elias Asfaw5Benjamin Uzochukwu6Tom Drake7Eleanor Bergren8Rosalind M. Eggo9Francis Ruiz10Nicaise Ndembi11Justice Nonvignon12Mark Jit13Anna Vassall14Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineDepartment of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineDepartment of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineDepartment of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical MedicineDepartment of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical MedicineHealth Economics Programme, Africa Centres for Disease Control and PreventionDepartment of Community Medicine, University of Nigeria NsukkaCentre for Global Development, Great Peter HouseDepartment of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical MedicineDepartment of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineDepartment of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical MedicineInstitute of Human Virology, University of Maryland School of MedicineHealth Economics Programme, Africa Centres for Disease Control and PreventionDepartment of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineDepartment of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical MedicineAbstract Background The COVID-19 vaccine supply shortage in 2021 constrained roll-out efforts in Africa while populations experienced waves of epidemics. As supply improves, a key question is whether vaccination remains an impactful and cost-effective strategy given changes in the timing of implementation. Methods We assessed the impact of vaccination programme timing using an epidemiological and economic model. We fitted an age-specific dynamic transmission model to reported COVID-19 deaths in 27 African countries to approximate existing immunity resulting from infection before substantial vaccine roll-out. We then projected health outcomes (from symptomatic cases to overall disability-adjusted life years (DALYs) averted) for different programme start dates (01 January to 01 December 2021, n = 12) and roll-out rates (slow, medium, fast; 275, 826, and 2066 doses/million population-day, respectively) for viral vector and mRNA vaccines by the end of 2022. Roll-out rates used were derived from observed uptake trajectories in this region. Vaccination programmes were assumed to prioritise those above 60 years before other adults. We collected data on vaccine delivery costs, calculated incremental cost-effectiveness ratios (ICERs) compared to no vaccine use, and compared these ICERs to GDP per capita. We additionally calculated a relative affordability measure of vaccination programmes to assess potential nonmarginal budget impacts. Results Vaccination programmes with early start dates yielded the most health benefits and lowest ICERs compared to those with late starts. While producing the most health benefits, fast vaccine roll-out did not always result in the lowest ICERs. The highest marginal effectiveness within vaccination programmes was found among older adults. High country income groups, high proportions of populations over 60 years or non-susceptible at the start of vaccination programmes are associated with low ICERs relative to GDP per capita. Most vaccination programmes with small ICERs relative to GDP per capita were also relatively affordable. Conclusion Although ICERs increased significantly as vaccination programmes were delayed, programmes starting late in 2021 may still generate low ICERs and manageable affordability measures. Looking forward, lower vaccine purchasing costs and vaccines with improved efficacies can help increase the economic value of COVID-19 vaccination programmes.https://doi.org/10.1186/s12916-023-02784-zVaccinationCOVID-19 | SARS-CoV-2Economic evaluationAffordabilityMathematical modelsDecision-making |
| spellingShingle | Yang Liu Simon R. Procter Carl A. B. Pearson Andrés Madriz Montero Sergio Torres-Rueda Elias Asfaw Benjamin Uzochukwu Tom Drake Eleanor Bergren Rosalind M. Eggo Francis Ruiz Nicaise Ndembi Justice Nonvignon Mark Jit Anna Vassall Assessing the impacts of COVID-19 vaccination programme’s timing and speed on health benefits, cost-effectiveness, and relative affordability in 27 African countries BMC Medicine Vaccination COVID-19 | SARS-CoV-2 Economic evaluation Affordability Mathematical models Decision-making |
| title | Assessing the impacts of COVID-19 vaccination programme’s timing and speed on health benefits, cost-effectiveness, and relative affordability in 27 African countries |
| title_full | Assessing the impacts of COVID-19 vaccination programme’s timing and speed on health benefits, cost-effectiveness, and relative affordability in 27 African countries |
| title_fullStr | Assessing the impacts of COVID-19 vaccination programme’s timing and speed on health benefits, cost-effectiveness, and relative affordability in 27 African countries |
| title_full_unstemmed | Assessing the impacts of COVID-19 vaccination programme’s timing and speed on health benefits, cost-effectiveness, and relative affordability in 27 African countries |
| title_short | Assessing the impacts of COVID-19 vaccination programme’s timing and speed on health benefits, cost-effectiveness, and relative affordability in 27 African countries |
| title_sort | assessing the impacts of covid 19 vaccination programme s timing and speed on health benefits cost effectiveness and relative affordability in 27 african countries |
| topic | Vaccination COVID-19 | SARS-CoV-2 Economic evaluation Affordability Mathematical models Decision-making |
| url | https://doi.org/10.1186/s12916-023-02784-z |
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