Building the concept for WHO Evidence Considerations for Vaccine Policy (ECVP): Tuberculosis vaccines intended for adults and adolescents as a test case

Kochhar, Sonali; Barreira, Dráurio; Beattie, Pauline; Cavaleri, Marco; Cravioto, Alejandro; Frick, Mike; Ginsberg, Ann M.; Hudson, Ian; Kaslow, David C.; Kurtz, Sherry L.; Lienhardt, Christian; Madhi, Shabir А.; Morgan, Chris; Momeni, Yalda; Patel, Deepali; Rees, Helen; Rogalski-Salter, Taryn; Schmidt, Alexander; Semete-Makokotlela, Boitumelo; Voss, Gérald; White, Richard G.; Zignol, Matteo; Giersing, Birgitte

doi:10.1016/j.vaccine.2021.10.062

Cited by 14 publications

(15 citation statements)

References 14 publications

(16 reference statements)

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“…41 Other context-specific considerations may also be decisive factors in the funding and implementation of MR-MAPs, and WHO recommends against basing health investment decisions purely on comparison to a cost-effectiveness threshold. 35 42 43…”

Section: Discussionmentioning

confidence: 99%

Impact and cost-effectiveness of measles vaccination through microarray patches in 70 low- and middle-income countries: a modelling study

Abbas

Malvolti³

et al. 2023

Preprint

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Background Microarray patches are a promising technology being developed to reduce barriers to vaccine delivery based on needles and syringes. To address the evidence gap on the public health value of applying this potential technology to immunisation programmes, we evaluated the health impact on measles burden and resulting cost-effectiveness of introducing measles-rubella microarray patches (MR-MAPs) in 70 low- and middle-income countries (LMICs). Methods We used an age-structured dynamic model of measles transmission and vaccination to project measles cases, deaths, and disability-adjusted life years during 2030─2040. Compared to the baseline scenarios with continuing current needle-based immunisation practice, we evaluated the introduction of MR-MAPs under different assumptions on measles vaccine coverage projections and MR-MAP introduction strategies. Costs were calculated based on the ingredients approach, including direct cost of measles treatment, vaccine procurement, and vaccine delivery. Model-based burden and cost estimates were derived for individual countries and country income groups. We compared the incremental cost-effectiveness ratios of introducing MR-MAPs to health opportunity costs. Results MR-MAPs introduction could prevent 27%─37% of measles burden between 2030─2040 in 70 LMICs. The largest health impact could be achieved under lower coverage projection and accelerated introduction strategy, with 39 million measles cases averted. Cost of measles treatment is a key driver of the net cost of introduction. In LMICs with a relatively higher income, introducing MR-MAPs could be a cost-saving intervention due to reduction in measles treatment costs. Compared to country-specific health opportunity costs, introducing MR-MAPs would be cost-effective in 16─81% of LMICs, depending on the MR-MAPs procurement price and vaccine coverage projections. Conclusions Introducing MR-MAPs in LMICs can be a cost-effective strategy to revitalise measles immunisation programmes with stagnant uptake and reach under-vaccinated children. Sustainable introduction and uptake of MR-MAPs has the potential to improve vaccine equity within and between countries and accelerate progress towards measles elimination.

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Section: Discussionmentioning

confidence: 99%

Impact and cost-effectiveness of measles vaccination through microarray patches in 70 low- and middle-income countries: a modelling study

Abbas

Malvolti³

et al. 2023

Preprint

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“…Finally, cost-effectiveness thresholds based on health opportunity costs may be useful in reflecting the value for money from a fixed budget perspective, but the methodology for this estimation has not yet been maturely developed, and only few countries have adopted these thresholds explicitly in decision-making for health policies 42. Other context-specific considerations may also be decisive factors in the funding and implementation of MR-MAPs, and WHO recommends against basing health investment decisions purely on comparison to a cost-effectiveness threshold 35 43 44…”

Section: Discussionmentioning

confidence: 99%

Impact and cost-effectiveness of measles vaccination through microarray patches in 70 low-income and middle-income countries: mathematical modelling and early-stage economic evaluation

Fu,

Abbas,

Malvolti

et al. 2023

BMJ Glob Health

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BackgroundMicroarray patches (MAPs) are a promising technology being developed to reduce barriers to vaccine delivery based on needles and syringes (N&S). To address the evidence gap on the public health value of applying this potential technology to immunisation programmes, we evaluated the health impact on measles burden and cost-effectiveness of introducing measles-rubella MAPs (MR-MAPs) in 70 low-income and middle-income countries (LMICs).MethodsWe used an age-structured dynamic model of measles transmission and vaccination to project measles cases, deaths and disability-adjusted life-years during 2030–2040. Compared with the baseline scenarios with continuing current N&S-based practice, we evaluated the introduction of MR-MAPs under different measles vaccine coverage projections and MR-MAP introduction strategies. Costs were calculated based on the ingredients approach, including direct cost of measles treatment, vaccine procurement and vaccine delivery. Model-based burden and cost estimates were derived for individual countries and country income groups. We compared the incremental cost-effectiveness ratios of introducing MR-MAPs to health opportunity costs.ResultsMR-MAP introduction could prevent 27%–37% of measles burden between 2030 and 2040 in 70 LMICs, compared with the N&S-only immunisation strategy. The largest health impact could be achieved under lower coverage projection and accelerated introduction strategy, with 39 million measles cases averted. Measles treatment cost is a key driver of the net cost of introduction. In countries with a relatively higher income, introducing MR-MAPs could be a cost-saving intervention due to reduced treatment costs. Compared with country-specific health opportunity costs, introducing MR-MAPs would be cost-effective in 16%–81% of LMICs, depending on the MR-MAPs procurement prices and vaccine coverage projections.ConclusionsIntroducing MR-MAPs in LMICs can be a cost-effective strategy to revitalise measles immunisation programmes with stagnant uptake and reach undervaccinated children. Sustainable introduction and uptake of MR-MAPs has the potential to improve vaccine equity within and between countries and accelerate progress towards measles elimination.

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“…The AIGHD/EDCTP Roadmap and WHO’s Evidence Considerations for Vaccine Policy 8,9 provided key implementation factors for ensuring public health impact in shaping our analytical framework. Four pivotal implementation research components were evaluated: (1) Epidemiological impact (e.g.…”

Section: Methodsmentioning

confidence: 99%

“…Figure 1. Conceptual framework of factors influencing implementation of TB vaccination among adults and adolescents 9,11 .…”

Section: Selection Of Articlesmentioning

confidence: 99%

Mapping the Existing Body of Knowledge on New and Repurposed TB Vaccine Implementation: A Scoping Review

Buis,

Jerene,

Gebhard

et al. 2024

Preprint

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There is global consensus on the urgent need for a safe and effective TB vaccine for adults and adolescents to improve global TB control, and encouragingly, several promising candidates have advanced to late-stage trials. Significant gaps remain in understanding the critical factors that will facilitate the successful implementation of new and repurposed TB vaccines in low- and middle-income countries (LMICs), once available. By synthesizing the existing body of knowledge, this review offers comprehensive insights into the current state of research on implementation of these adults and adolescent vaccines. This review explores four key dimensions: (1) epidemiological impact, (2) costing, cost-effectiveness, and/or economic impact, (3) acceptability, and the (4) feasibility of implementation; this includes implementation strategies of target populations, and health system capabilities. Results indicate that current research primarily consists of epidemiological and costing/cost-effectiveness/economic studies in India, China, and South Africa, mainly modelling with M72/AS01, BCG revaccination, and generic vaccines. Varying endpoints, vaccine efficacies, and vaccination coverages were used. Globally, new, and repurposed TB vaccines are estimated to save millions of lives. Economically, these vaccines also demonstrate promise with expected cost-effectiveness in most countries. Projected outcomes were dependent on vaccine characteristics, target population, implementation strategy, timing of roll out, TB burden/country context, and vaccination coverage. Potential barriers for vaccine acceptability included TB-related stigma, need for a second dose, and cost, while low pricing, community and civil society engagement and heightened public TB awareness were potential enablers in China, India, and South Africa. Potential implementation strategies considered spanned from mass campaigns to integration within existing vaccine programs and the primary target group studied was the general population, and adults and adolescents. In conclusion, future research must have broader geographical representations to better understand what is needed to inform tailored vaccine programs to accommodate diverse country contexts and population groups to achieve optimal implementation and impact. Furthermore, this review underscores the scarcity of research on acceptability of new and repurposed TB vaccines and their delivery among potential beneficiaries, the most promising implementation strategies, and the health system capabilities necessary for implementation. The absence of this knowledge in these areas emphasizes the crucial need for future research to ensure effective TB vaccine implementation in high burden settings worldwide.

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Building the concept for WHO Evidence Considerations for Vaccine Policy (ECVP): Tuberculosis vaccines intended for adults and adolescents as a test case

Cited by 14 publications

References 14 publications

Impact and cost-effectiveness of measles vaccination through microarray patches in 70 low- and middle-income countries: a modelling study

Impact and cost-effectiveness of measles vaccination through microarray patches in 70 low- and middle-income countries: a modelling study

Impact and cost-effectiveness of measles vaccination through microarray patches in 70 low-income and middle-income countries: mathematical modelling and early-stage economic evaluation

Mapping the Existing Body of Knowledge on New and Repurposed TB Vaccine Implementation: A Scoping Review

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