The Knowledge Hub

Expanding rotavirus vaccination coverage in Pakistan would greatly reduce deaths, especially among the poorest children

A cost-effectiveness analysis of rotavirus vaccination in Pakistan found that, if rotavirus vaccination coverage was equally high across regions and income groups, the percent reduction in deaths due to rotavirus would be 4 times greater in the highest risk regions than in the lowest-risk regions, and would be 3-4 times greater among children in the poorest versus the wealthiest households.

Expanding vaccination coverage among the poorest and most vulnerable children would substantially increase the overall impact of rotavirus immunization in Pakistan.

Rheingans R, Anderson JD, Bagamian KH et al.. 2018. Effects of geographic and economic heterogeneity on the burden of rotavirus diarrhea and the impact and cost-effectiveness of vaccination in Pakistan. Vaccine. 36(51).

Immunization against rotavirus is cost-effective, especially in poorer regions, saving lives and reducing disabilities

According to a cost-effectiveness study of rotavirus vaccination in Pakistan, the vaccine would be the most cost-effective in the poorer provinces of Sindh and Balochistan (that also have the highest rates of death from rotavirus)- with a cost per disability-adjust life year averted $155-$167 compared to almost $600 in the wealthier region of Islamabad. Within all regions, vaccination was the most cost-effective among the two poorest income groups (quintiles), and was almost 12 times more cost-effective in the poorest households in the most marginalized region than in the wealthiest households in the most advantaged region (cost/DALY averted of $76 vs. $897).

Rheingans R, Anderson JD, Bagamian KH et al.. 2018. Effects of geographic and economic heterogeneity on the burden of rotavirus diarrhea and the impact and cost-effectiveness of vaccination in Pakistan. Vaccine. 36(51).

Continuing vaccination in Kenya will prevent thousands of deaths and be cost-effective

An analysis in Kenya found that, although the government will need to more than double its current vaccine budget to continue using PCV after GAVI support ends, continuing the vaccination will prevent more than 101,000 cases of invasive pneumoccocal disease and pneumonia, more than 14,000 deaths over an 11-year period, and would be cost-effective (cost per DALY of $153 by 2032), even at the full GAVI price of US $3.05 per dose.

Ojal J, Griffiths U, Hammitt LL et al.. 2019. Sustaining pneumococcal vaccination after transitioning from Gavi support: a modelling and cost-effectiveness study in Kenya. Lancet Global Health. 7(5).

Administering hepatitis B immune globulin to newborns in addition to vaccination prevents more infections and is cost-effective

In a study of different strategies for preventing hepatitis B infections in newborns in a Burmese refugee population with a high infection rate, administering hepatitis B immune globulin to newborns whose mothers test positive through a rapid diagnostic test — in addition to vaccinating all newborns with a birth dose — prevented twice as many infections in newborns than vaccination alone and was cost-effective (while the current strategy of providing immune globulin only after a confirmatory lab test was done was not). Thus, this strategy could be considered for similar marginalized or poor populations.

Devine A, Harvey R, Min AM et al.. 2017. Strategies for the prevention of perinatal hepatitis B transmission in a marginalized population on the Thailand-Myanmar border: a cost-effectiveness analysis. BMC Infectious Diseases. 17(1).

Even in hard-to-reach areas measles vaccination is cost-effective and beneficial for public health

An outreach strategy in Kenya to vaccinate children against measles in hard-to-reach areas (e.g., beyond 5 km from a vaccination post) would be highly cost-effective, despite the higher cost per child to reach these children. The estimated cost per DALY averted ranged from US$122 (if 50% of these children receive the first dose and one-half of them the second dose) to US$274 (if 100% receive the first dose) — considerably less than the country’s GDP per capita of US$1,865 used as the threshold of cost-effectiveness.

Lee BY, Brown ST, Haidari LA et al.. 2019. Economic value of vaccinating geographically hard-to-reach populations with measles vaccine: A modeling application in Kenya. Vaccine. 37(17).

Adding hepatitis B vaccine to routine immunization for refugees in Africa reduces transmission and improves global health security

Adding a birth dose of hepatitis B vaccine to routine immunization of refugees in Africa — who have particularly high infection rates — is a highly cost-effective means of reducing transmission of the infection thus strengthening the overall global health security among these mobile, vulnerable populations.

Reardon JM, O'Connor SM, Njau JD et al.. 2019. Cost-effectiveness of birth-dose hepatitis B vaccination among refugee populations in the African region: a series of case studies. Conflict and Health. 13(5).

Immunization programs provide opportunities for cost-sharing with other health interventions

This study investigated the cost-effectiveness of multiple interventions against childhood pneumonia (including vaccination) and found that different combinations of expanded vaccine coverage with community or facility-based management, nutritional programs, or indoor air pollution measures maximized child health by providing the greatest health yield per dollar spent.

Niessen, L., ten Hove, A., Hilderink, H., et al. 2009. Comparative impact assessment of child pneumonia interventions. Bulletin of the World Health Organization. 87.