Feasibility of measles and rubella vaccination programmes for disease elimination: a modelling study

Winter, Amy; Lambert, Brian; Klein, Daniel J.; Klepac, Petra; Papadopoulos, Timos; Truelove, Shaun; Burgess, Colleen; Santos, Heather; Knapp, Jennifer K.; Reef, Susan E.; Kayembe, Lidia; Shendale, Stephanie; Kretsinger, Katrina; Lessler, Justin; Vynnycky, Emilia; McCarthy, Kevin; Ferrari, Matthew J.; Jit, Mark

doi:10.1016/s2214-109x(22)00335-7

Cited by 20 publications

(19 citation statements)

References 26 publications

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“…Such asynchrony was hypothesized to reduce the chances of extinction of measles across all geographies simultaneously. Indeed, despite consistent declines in incidence of measles for three decades after vaccine introduction, measles incidence is far above elimination and eradication targets (Winter et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

Metapopulations, the inflationary effect, and consequences for public health

Kortessis,

Glass,

Gonzalez

et al. 2023

Preprint

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The metapopulation perspective is an important conceptual framework in ecology and evolutionary ecology. Metapopulations are spatially distributed populations linked by dispersal. Both metapopulation models and their community and ecosystem level analogues, metacommunity and meta-ecosystem models, tend to be more stable regionally than locally and display enhanced abundance because of the interplay of spatiotemporal heterogeneity and dispersal (an effect that has been called the “inflationary effect”). We highlight the essential role of spatiotemporal heterogeneity in metapopulation biology, sketch empirical demonstrations of the inflationary effect, and provide a mechanistic interpretation of how the inflationary effect arises and impacts population growth and abundance. We illustrate the effect with examples from the spread of infectious disease. Namely, failure to recognize the full possible effects of spatiotemporal heterogeneity likely enhanced the spread of COVID-19, a failure based on lack of understanding of emergent population processes at large scales which may hamper control and eradication of other infectious diseases. We finish by noting how the effects of spatiotemporal heterogeneity have implicitly played roles in the history of ecology, ranging across subdisciplines as diverse as natural enemy-victim dynamics, species coexistence, and conservation biology. Seriously confronting the complexity of spatiotemporal heterogeneity could push many of these subdisciplines forward.

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Section: Discussionmentioning

confidence: 99%

Metapopulations, the inflationary effect, and consequences for public health

Kortessis,

Glass,

Gonzalez

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…In addition to being the most cost-effective, the Intensified Investment scenario is also the most likely to produce reductions in cases and deaths in countries that would achieve the threshold for elimination of measles and rubella, based on the results of the modelling 11. For measles, our previous modelling analysis found that the threshold of less than 5 cases per 1 000 000 is more likely to be reached in countries that are projected to reach high levels of coverage.…”

Section: Discussionmentioning

confidence: 99%

“…To estimate cost-effectiveness of MR vaccination, the impact of four different vaccination scenarios on measles and rubella incidence and mortality for 93 low-income and middle-income countries was calculated for the years 2018–2047, using mathematical models of measles and rubella transmission 11. It was assumed that the countries would remain in their 2018 World Bank income group12 during the period.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of measles and rubella elimination in low-income and middle-income countries

Levin¹,

Burgess²,

Shendale³

et al. 2023

BMJ Glob Health

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BackgroundSince 2000, the incidence of measles and rubella has declined as measles–rubella (MR) vaccine coverage increased due to intensified routine immunisation (RI) and supplementary immunisation activities (SIAs). The World Health Assembly commissioned a feasibility assessment of eliminating measles and rubella. The objective of this paper is to present the findings of cost-effectiveness analysis (CEA) of ramping up MR vaccination with a goal of eliminating transmission in every country.MethodsWe used projections of impact of routine and SIAs during 2018–2047 for four scenarios of ramping up MR vaccination. These were combined with economic parameters to estimate costs and disability-adjusted life years averted under each scenario. Data from the literature were used for estimating the cost of increasing routine coverage, timing of SIAs and introduction of rubella vaccine in countries.ResultsThe CEA showed that all three scenarios with ramping up coverage above the current trend were more cost-effective in most countries than the 2018 trend for both measles and rubella. When the measles and rubella scenarios were compared with each other, the most cost-effective scenario was likely to be the most accelerated one. Even though this scenario is costlier, it averts more cases and deaths and substantially reduces the cost of treatment.ConclusionsThe Intensified Investment scenario is likely the most cost-effective of the vaccination scenarios evaluated for reaching both measles and rubella disease elimination. Some data gaps on costs of increasing coverage were identified and future efforts should focus on filling these gaps.

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“…Measles and rubella have been verified as eliminated in 81 and 93 countries, respectively, as of 2020. 2,3 Given this fluid global context, Amy Winter and colleagues, in The Lancet Global Health, 4 modelled the probability of achieving measles and rubella elimination between 2018 and 2100 in 93 countries that currently bear the greatest measles and rubella burden. Five independent modelling groups collaborated on this tour-de-force effort to project the annual probability of measles and rubella elimination, conservatively defined in this report as 5 infections per million population, in each country under two different scenarios.…”

Section: Investing In Global Measles and Rubella Elimination Is Neede...mentioning

confidence: 99%

Investing in global measles and rubella elimination is needed to avert deaths and advance health equity

Raghunathan

Orenstein

2022

The Lancet Global Health

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Feasibility of measles and rubella vaccination programmes for disease elimination: a modelling study

Cited by 20 publications

References 26 publications

Metapopulations, the inflationary effect, and consequences for public health

Metapopulations, the inflationary effect, and consequences for public health

Cost-effectiveness of measles and rubella elimination in low-income and middle-income countries

Investing in global measles and rubella elimination is needed to avert deaths and advance health equity

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