Cost-effectiveness of COVID-19 vaccination in low- and middle-income countries

Abstract

SummaryDespite the advent of safe and highly effective COVID-19 vaccines1–4, pervasive inequities in global distribution persist5. In response, multinational partners have proposed programs to allocate vaccines to low- and middle-income countries (LMICs)6. Yet, there remains a substantial funding gap for such programs7. Further, the optimal vaccine supply is unknown and the cost-effectiveness of investments into global vaccination programs has not been described. We used a validated COVID-19 simulation model8 to project the health benefits and costs of reaching 20%-70% vaccine coverage in 91 LMICs. We show that funding 20% vaccine coverage over one year among 91 LMICs would prevent 294 million infections and 2 million deaths, with 26 million years of life saved at a cost of US$6.4 billion, for an incremental cost effectiveness ratio (ICER) of US$250/year of life saved (YLS). Increasing vaccine coverage up to 50% would prevent millions more infections and save hundreds of thousands of additional lives, with ICERs below US$8,000/YLS. Results were robust to variations in vaccine efficacy and hesitancy, but were more sensitive to assumptions about epidemic pace and vaccination costs. These results support efforts to fund vaccination programs in LMICs and complement arguments about health equity9, economic benefits10, and pandemic control11.

Uptake of the COVID-19 vaccine among healthcare workers in Malawi

“…High COVID-19 vaccine coverage in low- and middle-income countries is likely to be extremely cost-effective and save millions of lives. 4 There are however major global inequities in access to COVID-19 vaccines, 5 , 6 and gaps in our knowledge of factors likely to be associated with COVID-19 vaccine uptake and acceptability, which has primarily come from high-income countries. 7 , 8 The scant literature about COVID-19 vaccination from Africa to date has focused on COVID-19 vaccine acceptability and hesitancy rather than actual vaccination behaviors.…”

Cost-Effectiveness of COVID-19 Vaccination in Latin America and the Caribbean: An Analysis in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru

“…Also, our study has a variety of outcomes incorporated and reported, beyond Our work is in line with most economic evaluations of COVID-19 vaccination performed to date, either in peer-reviewed articles 5 6 7 8 9 10 11 12 13 32 , or pre-print. 4 In all of them, vaccination is shown to be either cost-effective -using commonly-used cost-effectiveness thresholds-or directly cost-saving. Usually, health technologies are initially available at a higher cost than in later periods 33 .…”

“…Vaccination for the recent SARS-CoV-2 pandemic has generally been implemented without formally assessing this dimension, given the global emergency it caused. More recently, several cost-effectiveness analyses of COVID-19 vaccination have been published [4][5][6][7][8][9][10][11][12] , most of them focused on high-income countries and only one with a speci c focus on a Latin American country 13 .…”

Vaccination Schedule under Conditions of Limited Vaccine Production Rate

“…They are the basis for overall planning and implementation of activities in individual countries, e.g., [21]. The prices and methods of vaccine distribution that differ between countries depending on their affluence have become an important issue [22,23]. Vaccination strategies are analyzed from multiple global and local perspectives and concerning various parameters such as population specifics, vaccine availability, vaccination logistics, etc.…”