Which countries need COVID-19 vaccines the most? Development of a prioritisation tool (preprint)

Background Assessing relative needs for COVID-19 vaccines across countries has been challenging. The objective of this study was to identify the most important factors for assessing country needs for vaccines, and to weight each, generating a scoring tool for prioritising countries. Methods The study was conducted between March and November 2021. The first stage involved a Delphi survey with a purposive and snowball sample of public health experts, to reach consensus on country-level factors for assessing relative needs for COVID-19 vaccines. The second stage involved a discrete choice experiment (DCE) to determine weights for the factors. Results The study included 28 experts working across 13 different countries and globally. The Delphi survey found 37 factors related to needs. Nine of the most important factors were included in the DCE. Among these, the most important factor was the proportion of overall population not fully vaccinated with a mean weight of 19.5, followed by proportion of high-risk population not fully vaccinated (16.1), health system capacity (14.2), capacity to purchase vaccines (11.9) and the proportion of the population clinically vulnerable (11.3). Conclusions By assessing relative needs, this scoring tool can build on existing methods to further the role of equity in global COVID-19 vaccine allocation.

Economic Impact of TB Mortality in 120 Countries and What It Will Cost If We Don't Achieve the End TB Targets: A Full-Income Analysis (preprint)

Background: Meeting the End TB mortality target by 2030, a 90% reduction compared to 2015 levels seems increasingly improbable. To assess the economic impact of not meeting the End TB mortality target by 2030, and alternatively 2045, a full income economic analysis was performed, using data from 120 countries. Methods: Mortality risk reductions were calculated based on the End TB mortality target being met in 2030 and 2045. The annual mortality risk change at each age interval, was converted into full-income risk, multiplying the rescaled population mortality risk change by the value-of-a-statistical-life year, computed as a proportion of Gross Domestic Product (GDP). The Cost of Inaction was calculated as the difference in full-income losses if the End TB target is met in 2030 compared to 2045. Impact on life expectancies, at birth and at age 35, were also estimated for these different end dates. Results: From 2020 to 2050, based on current trends, there would be 31.8 million TB deaths and full-income losses amounting to US$17.5 trillion (mean=US$230 million; SD=US$26 billion). If the End TB mortality target is met in 2030, US$13.2 trillion of the losses can be avoided. If met in 2045, US$10.2 trillion can be avoided. The additional cost of not meeting the End TB target until 2045 would be 5.7 million deaths and US$2.96 trillion in economic losses. Interpretation: Failure to achieve the End TB mortality target by 2030 will lead to profound full-income losses. The impact of delay will be greatest in sub-Saharan Africa where full-income losses in 15 countries will contribute more than 10% of annual GDP reduction. Impacted countries, donor nations and the private sector should redouble efforts to finance TB programs and research, since the economic dividend of such strategies is likely to be profound.Funding Statement: This analysis was undertaken without extramural funding.Declaration of Interests: The authors declare that we have no conflicts of interest.

Macro Level Influences on Strategic Responses to the COVID-19 Pandemic - A Tool for National Assessments (preprint)

Background: Variation in the approaches taken to contain the SARS-CoV-2 (COVID-19) pandemic at country level has been shaped by economic and political considerations, technical capacity, and assumptions about public behaviours. To address the limited application of learning from previous pandemics, this study aimed to analyse perceived facilitators and inhibitors during the pandemic and to inform the development of an assessment tool for pandemic response planning.Methods: A cross-sectional electronic survey of health and non-healthcare professionals (5 May - 5 June 2020) in six languages, with respondents recruited via email, social media and website posting. Participants were asked to score inhibitors (-10 to 0) or facilitators (0 to +10) impacting country response to COVID-19 from the following domains – Political, Economic, Sociological, Technological, Ecological, Legislative, and wider Industry (the PESTELI framework). Participants were then asked to explain their responses using free text. Descriptive and thematic analysis was followed by triangulation with the literature and expert validation to develop the assessment tool, which was then compared with four existing pandemic planning frameworks.Findings: 928 respondents from 66 countries (57% healthcare professionals) participated. Political and economic influences were consistently perceived as powerful negative forces and technology as a facilitator across high- and low-income countries. The 103-item tool developed for guiding rapid situational assessment for pandemic planning is comprehensive when compared to existing tools and highlights the interconnectedness of the 7 domains.Interpretation: The tool developed and proposed addresses the problems associated with decision making in disciplinary silos and offers a means to refine future use of epidemic modelling.Funding Statement: This study did not receive any external funding.Declaration of Interests: None to declare. Ethics Approval Statement: The study was approved by the Joint Research Compliance Office, Imperial College London (ICREC reference: 20IC5947).