One vaccine to counter many diseases? Modeling the economics of oral polio vaccine against child mortality and COVID-19

  1. Angela Y. Chang
  2. Peter Aaby
  3. Michael S. Avidan
  4. Christine S. Benn
  5. Stefano M. Bertozzi
  6. Lawrence Blatt
  7. Konstantin Chumakov
  8. Shabaana A. Khader
  9. Shyam Kottilil
  10. Madhav Nekkar
  11. Mihai G. Netea
  12. Annie Sparrow
  13. Dean T. Jamison

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Abstract

Recent reviews summarize evidence that some vaccines have heterologous or non-specific effects (NSE), potentially offering protection against multiple pathogens. Numerous economic evaluations examine vaccines' pathogen-specific effects, but less than a handful focus on NSE. This paper addresses that gap by reporting economic evaluations of the NSE of oral polio vaccine (OPV) against under-five mortality and COVID-19.

Materials and methods

We studied two settings: (1) reducing child mortality in a high-mortality setting (Guinea-Bissau) and (2) preventing COVID-19 in India. In the former, the intervention involves three annual campaigns in which children receive OPV incremental to routine immunization. In the latter, a susceptible-exposed-infectious-recovered model was developed to estimate the population benefits of two scenarios, in which OPV would be co-administered alongside COVID-19 vaccines. Incremental cost-effectiveness and benefit-cost ratios were modeled for ranges of intervention effectiveness estimates to supplement the headline numbers and account for heterogeneity and uncertainty.

Results

For child mortality, headline cost-effectiveness was $650 per child death averted. For COVID-19, assuming OPV had 20% effectiveness, incremental cost per death averted was $23,000–65,000 if it were administered simultaneously with a COVID-19 vaccine <200 days into a wave of the epidemic. If the COVID-19 vaccine availability were delayed, the cost per averted death would decrease to $2600–6100. Estimated benefit-to-cost ratios vary but are consistently high.

Discussion

Economic evaluation suggests the potential of OPV to efficiently reduce child mortality in high mortality environments. Likewise, within a broad range of assumed effect sizes, OPV (or another vaccine with NSE) could play an economically attractive role against COVID-19 in countries facing COVID-19 vaccine delays.

Funding

The contribution by DTJ was supported through grants from Trond Mohn Foundation (BFS2019MT02) and Norad (RAF-18/0009) through the Bergen Center for Ethics and Priority Setting.

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  1. Version published to 10.3389/fpubh.2022.967920
  2. ScreenIT

    SciScore for 10.1101/2022.01.19.22269560: (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: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Nonetheless the study has a number of limitations First, while the effectiveness of OPV in preventing a variety of respiratory infections has been documented, to date, there is no empirical estimate on the effect of OPV in reducing transmission of SARS-CoV-2 or severity of COVID-19. A recent randomized trial of BCG vaccination, another LAV, found that BCG revaccination decreased COVID-19 risk by 68% among the older adults, whereas a press release from another randomized trial testing a primary dose of BCG among older adults reported no effect on COVID-19 incidence.(14,30) Biologically and epidemiologically plausible evidence suggest that there may be a beneficial effect of OPV in relation to COVID-19.(9,31) We therefore applied a wide range of effectiveness estimates in our sensitivity analysis to account for this uncertainty. If future clinical trials show a zero effect of OPV against COVID-19, then the analyses above would be superfluous. Second, our SEIR model is basic and does not account for more nuanced aspects of the dynamic. For example, it does not account for heterogeneity in population mixing patterns nor model more than one epidemic wave. However, if the vaccines are deployed during the first wave, as we have assumed, the following waves should not impact our results because of our focus on the marginal benefits and costs between scenarios. Other model limitations include our assumptions that the duration of immunity for both vaccines last longer than the length o...

    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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  3. Version published to 10.1101/2022.01.19.22269560v1 on medRxiv