Assessing the impacts of timing on the health benefits, cost-effectiveness and relative affordability of COVID-19 vaccination programmes in 27 African Countries
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Abstract
Background
The COVID-19 vaccine supply shortage in 2021 constrained rollout efforts in Africa while populations experienced waves of epidemics. As supply picks up, a key question becomes if vaccination remains an impactful and cost-effective strategy given changes in the timing of implementation.
Methods
We assessed the impact of timing using an epidemiological and economic model. We fitted our mathematical epidemiological model to reported COVID-19 deaths in 27 African countries to estimate the existing immunity (resulting from infection) before substantial vaccine rollout. We then projected health outcomes for different programme start dates (2021-01-01 to 2021-12-01, n = 12) and roll-out rates (slow, medium, fast; 275, 826, and 2066 doses/ million population-day, respectively) for viral vector and mRNA vaccines. Rollout rates used were derived from observed uptake trajectories. We collected data on vaccine delivery costs by country income group. Lastly, we calculated incremental cost-effectiveness ratios and relative affordability.
Findings
Vaccination programmes with early start dates incur the most health benefits and are most cost-effective. While incurring the most health benefits, fast vaccine roll-outs are not always the most cost-effective. At a willingness-to-pay threshold of 0.5xGDP per capita, vaccine programmes starting in August 2021 using mRNA and viral vector vaccines were cost-effective in 6-10 and 17-18 of 27 countries, respectively.
Interpretation
African countries with large proportions of their populations unvaccinated by late 2021 may find vaccination programmes less cost-effective than they could have been earlier in 2021. Lower vaccine purchasing costs and/or the emergence of new variants may improve cost-effectiveness.
Funding
Bill and Melinda Gates Foundation, World Health Organization, National Institute of Health Research (UK), Health Data Research (UK)
Article activity feed
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SciScore for 10.1101/2022.05.09.22274846: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our study has several limitations. First, our epidemic model may not have captured the full complexity of the immune dynamics against SARS-CoV-2, which involves both vaccination and infections. For example, our model assumed that vaccinated individuals who had prior infection histories are completely protected against SARS-CoV-2. This design is intended to make sure that most individuals within the model receive a maximum of two doses. However, …
SciScore for 10.1101/2022.05.09.22274846: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our study has several limitations. First, our epidemic model may not have captured the full complexity of the immune dynamics against SARS-CoV-2, which involves both vaccination and infections. For example, our model assumed that vaccinated individuals who had prior infection histories are completely protected against SARS-CoV-2. This design is intended to make sure that most individuals within the model receive a maximum of two doses. However, we cannot capture a small number of breakthrough infections that may still happen. However, these tend to be mild cases and thus should not affect our results substantially. (23) Second, the vaccine delivery and healthcare costs used for most countries in our study were extrapolated based on a small number of countries of different income groups, which may introduce bias. More accurate country-specific cost data should be incorporated. Third, for calculating YLLs, there was a lack of empirical evidence on the baseline life expectancy for COVID-19 deaths compared to that of the general population, although we explored different assumptions in the sensitivity analysis. Further research on COVID-19 death risk profiles may provide further insights into their differences. Fourth, our costs do not account for increased prices of scarce resources that may be associated with the pace of the roll-out, which would increase opportunity costs. Moreover, we do not use observed costs of different vaccination programmes, as this data is not yet avail...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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