ABSTRACT
Objectives: We estimated the cost-effectiveness of non-pharmaceutical interventions (NPI), vaccines, and the combination of NPI and vaccines in managing the COVID pandemic. Method(s): A dynamic transmission model was constructed to simulate the incidence of COVID infections and deaths among community-dwelling Singapore residents. Using this model, we compared the cost and outcomes of NPI (border control measures, safe distancing and mask wearing) versus no NPI in an unvaccinated and a vaccinated population. The analysis was conducted from the societal perspective over a one year time horizon, with data based on the COVID situation in Singapore during Jan 2021 to Dec 2021. Costs of vaccination, adverse events, masks, self-testing using rapid antigen tests, test-trace-isolate (TTI), outpatient visits, hospitalization, productivity loss and reduced sales receipt from retail and food and beverages industries were included. Health loss from adverse events, TTI and COVID infection and deaths were also included. Result(s): Among the scenarios compared, vaccination combined with NPIs yield the lowest cost (S$7.6 billion), while no vaccination with NPIs had the highest costs (S$49.1 billion). The largest loss in QALYs from the population was seen from the scenario without vaccination or NPIs. Using a dominance approach, vaccination combined with NPIs is cost saving with an ICER of -S$213 billion per QALY, compared to no vaccination with lockdown measures. The results show that NPIs alone without vaccination only delays transmission, but does not significantly change the total number of cases observed in the population. Vaccination is both cost saving and health saving as the difference in cases averted from vaccination and their associated costs, is far greater than the additional costs required to vaccinate the public. Conclusion(s): Both vaccination and NPI are critical strategies for managing the COVID pandemic. In the presence of vaccine, NPIs continue to offer benefits in terms of reduced number of infections and deaths.Copyright © 2023
ABSTRACT
Objectives The availability of COVID-19 vaccines is gradually changing the world, allowing countries to combat the pandemic using an offensive rather than defensive approach. The decisions to procure and manage the vaccines are influenced by a country's health system, its economic status, international politics as well as national interests. This study looks at this dynamic in Thailand through the lens of a political economy analysis to understand the distribution and influence of power and resources in procuring vaccines for an upper-middle income country. Methods We conducted a document review and interviews with key stakeholders to gain insights into the health system and political economy implications of Thailand's COVID-19 vaccine procurement strategies. The data was analysed using a framework developed by Fritz, Kaiser, and Levy in 2009 on political economy analysis focusing on structural, institutional and stakeholder-related factors. Results Thailand had been successful in containing COVID-19, however, a proactive approach to planning and procuring COVID-19 vaccines was not employed. Thailand did not join the multi-lateral COVAX Facility, and instead relied on two manufacturers. It also pursued a vaccine security policy by supporting domestic production of a COVID-19 vaccine. As of July 2021, the country has vaccinated 5.2% of its population, which is lower than the global average. Relevant groups and stakeholders in the vaccine policy landscape include the Ministry of Public Health, the National Vaccine Institute, Government Pharmaceutical Organization, private hospitals, medical associations and the public among others. The study is at an early stage of analysis and results will be available in September 2021. Conclusion The complexities of COVID-19 vaccine policymaking necessitate a nuanced, multidisciplinary approach. Political economy analysis can be a useful tool in informing the various stages of the policy making process such as agenda-setting, policy design, adoption, implementation and evaluation.