Key Evidence: During and after the Ebola epidemic in a hard-hit region of Guinea, the increasing trend of child vaccination coverage was reversed resulting in a significant decrease in coverage for most vaccines. Despite an uptick immediately following the end of the outbreak, the downward trend continued or plateaued for all vaccines.
The Outbreaks sub-topic explores issues related to the occurrence of vaccine-preventable diseases in a population at levels above the expected baseline, including the widespread consequences for the health system, economic growth, social and political stability beyond the immediate impact on the health of those affected, as well as the importance of primary prevention through high rates of immunization coverage.
7 Key Concepts
Key Evidence: Although the upfront investment in preparedness is costly – severe influenza pandemic preparedness is US$4.5bn a year – the estimated annual economic benefits would total US$60bn and US$490bn through averted deaths. “Even if only one tenth of these benefits were to materialize, the returns to public investment in preparedness would still be extraordinarily high.”
Key Evidence: In a study of a 2003 outbreak of pertussis in the U.S., including 17 cases among healthcare workers, researchers estimated that vaccinating healthcare workers would prevent nearly 50% of disease exposures by healthcare workers per year.
Key Evidence: Using data on the spread of Ebola from person to person during historical Ebola outbreaks to compare vaccination strategies, researchers found that prophylatically vaccinating all healthcare workers would have decreased the number of disease cases in the 2014 epidemics in Guinea and Nigeria by 60-80%.
Key Evidence: Meningococcal meningitis epidemics in Burkina Faso “… disrupted all health services from national to operational levels,…” according to a 2011 study. Impacts included a shortage of available hospital beds and medicines, a reduction or delay in routine lab analyses for other diseases, longer wait times, and an increase in misdiagnoses by overtaxed health workers.
Key Evidence: Fear of Ebola during the 2014-2016 epidemic in 3 West African countries had a major impact on the health sector in neighboring Nigeria, where hospitals reported sharp decreases in patient volume resulting in major financial losses. Some hospitals also turned away febrile patients to prevent being associated with Ebola while staff in other hospitals abandoned their posts.
Key Evidence: The potential for a spike in COVID-19 concurrent with influenza season could threaten to overwhelm healthcare systems, particularly in resource-limited contexts. A double burden of influenza and COVID-19 cases could also increase risk of cross-infection and transmission in hospital settings. This mathematical modeling study found that increasing influenza vaccine uptake would help manage respiratory outbreaks coinciding with peak flu season and thus reduce the potential strain on healthcare systems responding to COVID-19.
Key Evidence: A 2015 study projected that the crippling of immunization programs resulting from the 2014 Ebola epidemic in Guinea, Liberia, and Sierra Leone could double the number of people at risk of a measles outbreak, and could cause up to 16,000 measles deaths, surpassing the number of deaths caused by Ebola itself.
Key Evidence: A large meningococcal meningitis epidemic in Burkina Faso cost the health system an estimated US$7.1 million, representing nearly 2% of the country’s entire annual health budget.
From the VoICE editors: In this study of a 2007 outbreak, 86% of the health system cost covered a reactive vaccination campaign using older polysaccharide vaccines. Routine vaccination with new, conjugate vaccines are expected to prevent or limit future outbreaks and thus reduce these costs.
Key Evidence: A large measles outbreak in the Netherlands in 2013-14 resulted in 2700 cases of disease and cost an estimated US$4.7 million — or US$1,739 per case. Costs included outbreak response (including vaccination and enhanced surveillance), the cost of treatment (primarily hospitalizations), and the loss of productivity among caregivers ($365,000, less than 8% of total costs). Due to the likely under-reporting of the disease, the actual costs could be nearly 20% greater ($5.6 million).
Key Evidence: Two meningococcal meningitis outbreaks in Brazil resulted in US$128,000 (9 cases, 2007) and US$34,000 (3 cases, 2011) in direct costs to the health system to investigate cases and manage the outbreak (including emergency vaccination). The investigation and response activities related to the 2011 outbreak alone cost $11,475 per case, and an additional $6,600 overall for supplemental disease surveillance activities.
Key Evidence: According to the World Bank, the economic impact of the 2014-15 Ebola epidemic outlasted the epidemiological impact of outbreak, resulting in estimated losses of US$2.8 billion in Guinea, Liberia, and Sierra Leone (or 16% of their combined GDP).
Key Evidence: The US state of Iowa incurred more than US$140,000 in direct costs of outbreak containment stemming from a single case of measles in an unvaccinated student infected overseas. Swift containment procedure limited the outbreak to 3 additional cases but included significant and costly steps including tracking down contacts of the infected student, establishing a measles information hotline, testing exposed medical staff for immunity, conducting measles vaccination clinics, and putting quarantines into effect.
From the VoICE editors: Although even small outbreaks of highly contagious diseases can be exceedingly costly to contain, the value of containment to society is very high. Traditional economic evaluations of outbreaks which include just the costs of illness to individuals should be expanded to include the costs and value of containing the outbreak required to protect society.
Key Evidence: In a comprehensive accounting of the costs of the 2014 Ebola outbreak in West Africa, Huber et al. estimate the economic and social costs to have been US$53 billion, of which US$18.8 billion was attributed to non-Ebola deaths.
Key Evidence: A 2006-07 meningococcal meningitis epidemic in Burkina Faso cost households an average of US$90 for each case of meningitis that occurred. These costs — representing nearly 2.5 months of the average per capita income for that year — included direct and indirect costs of treatment and lost income to caretakers.
Key Evidence: A measles outbreak in the Federated States of Micronesia (FSM) in 2014, causing nearly 400 confirmed cases, cost nearly US$4 million (around US$10,000 per case), 88% of which was for a mass vaccination campaign, outbreak investigations, and other containment costs. While the U.S. government covered 2/3 of the costs, the economic burden to FSM — in labor and other costs of containing the outbreak, the direct costs of illness, and productivity losses — were the equivalent of the country’s entire education budget for one year.
Key Evidence: In an analysis of a hypothetical disease outbreak scenario, based on data from the Ebola epidemic in West Africa, researchers estimated that a large-scale disease outbreak spreading to nine Asian countries could cost the US economy $8-41 billion in lost exports and put almost 1.4 million export-related US jobs at risk.
Key Evidence: During the 2014-2016 Ebola epidemic in 3 West African countries, fear of the disease in neighboring Nigeria and misperceptions on how disease spreads negatively affected many sectors of the economy – retail, hospitality, airline industries, and certain agricultural sectors.
Key Evidence: A study of a cholera outbreak in Peru in 1991-92 estimates that the national economy conservatively suffered more than US$50 million in economic losses due to reduced tourism revenue, reduced revenue on export of goods and lower domestic consumption as a result of the outbreak of cholera.