ABSTRACT
Background
Despite the advent of safe and effective COVID-19 vaccines, pervasive inequities in global vaccination persist.
Methods
We projected health benefits and donor costs of delivering vaccines for up to 60% of the population in 91 low- and middle-income countries (LMICs). We modeled a highly contagious (Re at model start = 1.7), low-virulence (IFR = 0.32%) “omicron-like” variant and a similarly contagious “severe” variant (IFR = 0.59%) over 360 days, accounting for country-specific age structure and healthcare capacity. Costs included vaccination startup (US$630 million) and per-person procurement and delivery (US$12.46/person vaccinated).
Results
In the omicron-like scenario, increasing current vaccination coverage to achieve at least 15% in each of the 91 LMICs would prevent 11 million new infections and 120,000 deaths, at a cost of US$0.95 billion, for an incremental cost-effectiveness ratio (ICER) of US$670/year-of-life saved (YLS). Increases in vaccination coverage to 60% would additionally prevent up to 68 million infections and 160,000 deaths, with ICERs < US$8,000/YLS. ICERs were < US$4,000/YLS under the more severe variant scenario and generally robust to assumptions about vaccine effectiveness, uptake, and costs.
Conclusions
Funding expanded COVID-19 vaccine delivery in LMICs would save hundreds of thousands of lives, be similarly or more cost-effective than other donor-funded global aid programs, and improve health equity.
Keywords: COVID-19, COVAX, health equity, vaccination, low and middle-income countries, cost-effectiveness
Contributor Information
Mark J. Siedner, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa; Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Christopher Alba, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
Kieran P. Fitzmaurice, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
Rebecca F. Gilbert, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
Justine A. Scott, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
Fatma M. Shebl, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
Andrea Ciaranello, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard University Center for AIDS Research, Cambridge, MA, USA.
Krishna P. Reddy, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Kenneth A. Freedberg, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Supplementary Material
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