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Assessing the impacts of COVID-19 vaccination programme's timing and speed on health benefits, cost-effectiveness, and relative affordability in 27 African countries.
Liu, Yang; Procter, Simon R; Pearson, Carl A B; Montero, Andrés Madriz; Torres-Rueda, Sergio; Asfaw, Elias; Uzochukwu, Benjamin; Drake, Tom; Bergren, Eleanor; Eggo, Rosalind M; Ruiz, Francis; Ndembi, Nicaise; Nonvignon, Justice; Jit, Mark; Vassall, Anna.
  • Liu Y; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, UK. yang.liu@lshtm.ac.uk.
  • Procter SR; Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, UK. yang.liu@lshtm.ac.uk.
  • Pearson CAB; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.
  • Montero AM; Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.
  • Torres-Rueda S; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.
  • Asfaw E; Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.
  • Uzochukwu B; South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, Republic of South Africa.
  • Drake T; Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.
  • Bergren E; Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.
  • Eggo RM; Health Economics Programme, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia.
  • Ruiz F; Department of Community Medicine, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria.
  • Ndembi N; Centre for Global Development, Great Peter House, Abbey Gardens, Great College St, London, UK.
  • Nonvignon J; Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.
  • Jit M; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.
  • Vassall A; Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.
BMC Med ; 21(1): 85, 2023 03 08.
Article in English | MEDLINE | ID: covidwho-2269437
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Vaccines / COVID-19 Type of study: Experimental Studies / Observational study / Randomized controlled trials Topics: Long Covid / Vaccines Limits: Aged / Humans Country/Region as subject: Africa Language: English Journal: BMC Med Journal subject: Medicine Year: 2023 Document Type: Article Affiliation country: S12916-023-02784-z

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Vaccines / COVID-19 Type of study: Experimental Studies / Observational study / Randomized controlled trials Topics: Long Covid / Vaccines Limits: Aged / Humans Country/Region as subject: Africa Language: English Journal: BMC Med Journal subject: Medicine Year: 2023 Document Type: Article Affiliation country: S12916-023-02784-z