National stakeholder preferences for next-generation rotavirus vaccines: Results from a six-country study

Price, Jessica; Mooney, Jessica; Bain, Carolyn; Bawa, John; Gurley, Nikki; Kumar, Amresh; Liyanage, Guwani; Mkisi, Rouden; Odero, Chris; Seck, Karim; Simpson, Evan; Hausdorff, William P.

doi:10.1016/j.vaccine.2021.11.009

Cited by 8 publications

(9 citation statements)

References 30 publications

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“…These results should be considered alongside those from a recent feasibility and acceptability study conducted among national stakeholders and healthcare workers in several LMICs that showed substantial interest in iNGRVs, especially if they were part of a larger DTP combination. 45 Taken together, these analyses required us to make several assumptions yet to be confirmed by clinical studies but would support a positive public health value proposition for the next generation of injectable rotavirus vaccines in LMICs.…”

Section: Discussionmentioning

confidence: 99%

Potential impact and cost-effectiveness of injectable next-generation rotavirus vaccines in 137 LMICs: a modelling study

Debellut¹,

Pecenka

Hausdorff

et al. 2022

Human Vaccines & Immunotherapeutics

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While current live, oral rotavirus vaccines (LORVs) are reducing severe diarrhea everywhere, their effectiveness is lower in high burden settings. Alternative approaches are in advanced stages of clinical development, including injectable next-generation rotavirus vaccine (iNGRV) candidates, which have the potential to better protect children, be combined with existing routine immunizations and be more affordable than current LORVs. In an effort to better understand the real public health value of iNGRVs and to help inform decisions by international agencies, funders, and vaccine manufacturers, we conducted an impact and cost-effectiveness analysis examining 20 rotavirus vaccine use cases. We evaluated several currently licensed LORVs, one neonatal oral NGRV (oNGRV), one iNGRV, and one iNGRV-DTP (iNGRV comprising part of a DTP-containing combination) over a ten-year timeframe in 137 low- and middle-income countries. The most promising use case identified was a high efficacy iNGRV-DTP, predicted to have the lowest vaccine program cost (US$1.4 billion), the highest vaccine benefit (750,000 rotavirus deaths averted, 13 million rotavirus hospital admissions averted, US$ 2.7 billion health-care cost averted), and most favorable cost-effectiveness (cost-saving). iNGRV-DTP vaccine remained the most affordable, safe, and cost-effective option even when it was assumed to have equivalent efficacy to the current LORVs. This study shows that while the development of iNGRVs with superior efficacy to currently licensed LORVs would be ideal, iNGRVs with similar efficacy to LORVs would offer substantial public health value. It also highlights the economic value of accelerating the development of DTP-based combination vaccines that include iNGRV to provide rotavirus protection.

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Section: Discussionmentioning

confidence: 99%

Potential impact and cost-effectiveness of injectable next-generation rotavirus vaccines in 137 LMICs: a modelling study

Debellut¹,

Pecenka

Hausdorff

et al. 2022

Human Vaccines & Immunotherapeutics

Self Cite

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“…Findings from this study add to the existing literature on vaccine assessments, value propositions, and investment cases [ 34 – 37 ], including a complementary paper reporting on national stakeholder findings regarding NGRVs [ 21 ]. Interviews with HPs on vaccine preferences elucidated potential barriers and facilitators for NGRV delivery, which align with previously published findings around vaccine feasibility and acceptability in LMIC settings [ 23 , 38 ].…”

Section: Discussionmentioning

confidence: 83%

“…To better understand potential market success of NGRVs within the current rotavirus vaccine landscape, PATH developed a value proposition to understand the public health value of NGRVs to help inform decisions by international agencies, funders, vaccine manufacturers, and countries. The value proposition has three main components: (1) a mixed-method study to elicit both national stakeholder (NS) and healthcare provider (HP) views on the feasibility and acceptability (F&A) of real and hypothetical NGRV candidates with different characteristics and benefits (HPs views are the subject of this paper; NS findings are reported elsewhere [ 21 ]); (2) economic modeling to project the impact and cost-effectiveness of real and hypothetical NGRVs compared to currently available LORVs [ 22 ]; and (3) informed by findings from #1 and #2, demand forecasting to quantify potential market sizes for new vaccine options.…”

Section: Introductionmentioning

confidence: 99%

Healthcare provider perspectives on delivering next generation rotavirus vaccines in five low-to-middle-income countries

Mooney

Price²,

Bain³

et al. 2022

PLoS ONE

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Background Live oral rotavirus vaccines (LORVs) have significantly reduced rotavirus hospitalizations and deaths worldwide. However, LORVs are less effective in low- and middle-income countries (LMICs). Next-generation rotavirus vaccines (NGRVs) may be more effective but require administration by injection or a neonatal oral dose, adding operational complexity. Healthcare providers (HPs) were interviewed to assess rotavirus vaccine preferences and identify delivery issues as part of an NGRV value proposition. Objective Determine HP vaccine preferences about delivering LORVs compared to injectable (iNGRV) and neonatal oral (oNGRV) NGRVs. Methods 64 HPs from Ghana, Kenya, Malawi, Peru, and Senegal were interviewed following a mixed-method guide centered on three vaccine comparisons: LORV vs. iNGRV; LORV vs. oNGRV; oNGRV vs. iNGRV. HPs reviewed attributes for each vaccine in the comparisons, then indicated and explained their preference. Additional questions elicited views about co-administering iNGRV+LORV for greater public health impact, a possible iNGRV-DTP-containing combination vaccine, and delivering neonatal doses. Results Almost all HPs preferred oral vaccine options over iNGRV, with many emphasizing an aversion to additional injections. Despite this strong preference, HPs described challenges delivering oral doses. Preferences for LORV vs. oNGRV were split, marked by disparate views on rotavirus disease epidemiology and the safety, need, and feasibility of delivering neonatal vaccines. Although overwhelmingly enthusiastic about an iNGRV-DTP-containing combination option, several HPs had concerns. HP views were divided on the feasibility of co-administering iNGRV+LORV, citing challenges around logistics and caregiver sensitization. Conclusion Our findings provide valuable insights on delivering NGRVs in routine immunization. Despite opposition to injectables, openness to co-administering LORV+iNGRV to improve efficacy suggests future HP support of iNGRV if adequately informed of its advantages. Rationales for LORV vs. oNGRV underscore needs for training on rotavirus epidemiology and stronger service integration. Expressed challenges delivering existing LORVs merit further examination and indicate need for improved delivery.

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“…To have sufficient validity, these consultations should comprise multi-country indepth analyses that involve national opinion leaders, policymakers, and finance officials, as well as selected health care providers. These could include structured or semi-structured interviews, open-ended or discrete choice surveys, formal and informal consultations of many kinds, and successful examples exist for other pathogens [35,36]. Such analyses could also be useful to better understand what LMIC stakeholders consider to be the optimal schedule for a Shigella vaccine.…”

Section: Further Efforts To Better Understand the Value Of Shigella V...mentioning

confidence: 99%

“…What LMIC stakeholders think Systematic consultation with stakeholders [35,36] Ultimate deciders of vaccine prioritization and introduction…”

Section: Prospect Of a Healthy Competitive And Sustainable Vaccine Ma...mentioning

confidence: 99%

What Drives the Value of a Shigella Vaccine?

2022

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The development and licensure of a safe and highly efficacious Shigella vaccine has been a priority in international public health circles for decades and would represent a great scientific achievement. Nonetheless, in the context of increasingly crowded and costly childhood immunization programs, and with a myriad of other new and improved vaccines currently or soon on the market, there is no guarantee that even a highly effective Shigella vaccine would become a priority for adoption and introduction by the low- and middle-income countries that could benefit from it the most. We discuss here some of the major determinants and questions regarding the introduction of Shigella vaccines and the importance of developing a succinct, compelling public health value proposition.

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National stakeholder preferences for next-generation rotavirus vaccines: Results from a six-country study

Cited by 8 publications

References 30 publications

Potential impact and cost-effectiveness of injectable next-generation rotavirus vaccines in 137 LMICs: a modelling study

Potential impact and cost-effectiveness of injectable next-generation rotavirus vaccines in 137 LMICs: a modelling study

Healthcare provider perspectives on delivering next generation rotavirus vaccines in five low-to-middle-income countries

What Drives the Value of a Shigella Vaccine?

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