Lessons learnt from UNAIDS virtual technical support to countries applying for funding from the Global Fund COVID-19 Response Mechanism.

In 2020 the Global Fund for AIDS, Tuberculosis and Malaria initiated a new funding modality, the COVID-19 Response Mechanism, to mitigate the pandemic's effects on HIV, TB and malaria programmes and health systems in implementer countries. In 2021 UNAIDS introduced an innovative technical virtual support mechanism for COVID-19 Response Mechanism proposal development to help countries quickly implement COVID-19 interventions while at the same time adapting HIV and related services to the pandemic's circumstances and mitigate its impact while maintaining hard-won gains. It also intended to ensure more attention was paid to communities, human rights and gender considerations in proposal development, resulting in successful proposals to mitigate COVID-19's impact, bring human rights-based and people-centred HIV programmes back on track and even expand their reach through using new delivery platforms. In 2021, applications from 18 sub-Saharan African and Asian countries received in-depth remote peer reviews. We discuss the reviews' key findings and recommendations to improve proposal quality and identify future opportunities for virtual technical support. The model was successful and contributed to better quality funding applications, but also highlighted challenges in pandemic mitigation, adaptations and innovations of HIV programmes. Countries still fell short on comprehensive community, human rights and gender interventions, as well as innovations in HIV service delivery, especially in prevention and gender-based violence. Several other weaknesses meant that some countries would have to refine their programme design and implementation model in the final version of their funding application. There are implications for future assistance to countries trying to mitigate the impact of COVID-19 on their health programmes and innovative ways to deliver technical support using new technologies and local expertise.

Cost-effectiveness of hepatitis A vaccine in prevention of secondary hepatitis A infection.

Using a decision-tree based model, we investigated the cost-effectiveness of several vaccination strategies for household, day care center and nursery/primary school contacts of primary cases of hepatitis A in France. Depending on the age groups vaccinated, the cost per symptomatic case avoided varied between 700 and 1,300 Euro (1 Euro = 0.93 US dollars) for household contacts. Vaccination of contacts in day care centers and schools resulted in cost-savings. However, these findings are contingent on the limited and controversial data available on vaccine protective efficacy. In particular, the question of the relative efficacy of vaccination as compared with the use of immunoglobulins needs further study.

Economic evaluation of vaccination programmes: a consensus statement focusing on viral hepatitis.

The methods that have been used to estimate the clinical and economic impact of vaccination programmes are not always uniform, which makes it difficult to compare results between economic analyses. Furthermore, the relative efficiency of vaccination programmes can be sensitive to some of the more controversial aspects covered by general guidelines for the economic evaluation of healthcare programmes, such as discounting of health gains and the treatment of future unrelated costs. In view of this, we interpret some aspects of these guidelines with respect to vaccination and offer recommendations for future analyses. These recommendations include more transparency and validation, more careful choice of models (tailored to the infection and the target groups), more extensive sensitivity analyses, and for all economic evaluations (also nonvaccine related) to be in better accordance with general guidelines. We use these recommendations to interpret the evidence provided by economic evaluation applied to viral hepatitis vaccination. We conclude that universal hepatitis B vaccination (of neonates, infants or adolescents) seems to be the most optimal strategy worldwide, except in the few areas of very low endemicity, where the evidence to enable a choice between selective and universal vaccination remains inconclusive. While targeted hepatitis A vaccination seems economically unattractive, universal hepatitis A vaccination strategies have not yet been sufficiently investigated to draw general conclusions.