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Comparing Vaccination Strategies: Assessing Disease Burden and Cost-Effectiveness

This article provides an overview of the work done by the WHO in comparing vaccination strategies, estimating disease burden, and assessing cost-effectiveness. It includes examples of current work, unmet needs, and methods used to assist countries in estimation, forecasting, and introduction of new vaccines. The article also discusses innovation in disease control and measures to monitor mortality and morbidity.

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Comparing Vaccination Strategies: Assessing Disease Burden and Cost-Effectiveness

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  1. Global Issues in Comparing Vaccination Strategies Dr Lara Wolfson Vaccine Assessment & Monitoring Department of Immunization, Vaccines & Biologicals

  2. Vaccination Strategies: WHO • Overview of work at WHO • Examples of current work • Unmet needs

  3. Estimates of current disease burden for vaccine-preventable diseases Forecasts of future disease burden & cost-effectiveness under different vaccination scenarios Methods and Materials to assist RO’s and countries in estimation and forecasting of disease burden, introduction of new vaccines, cost-effectiveness assessments Support to users of burden of disease data, technical assistance for cost-effectiveness Innovation Accelerated Disease Control Immunization Systems Measuring Mortality and Morbidity

  4. Independent studies / reports / models Complete vital registration Age-specific Incomplete vital mortality rates registration Epidemiological data from studies, verbal autopsies, WHO programme estimates (child, maternal, injuries, non-communicable, TB, HIV/AIDS) Sample registration system Censuses 5q0 45q15 DHS and other surveys No recent data Cause-specific UN population UN estimates mortality patterns estimates All-cause mortality Country level age, sex and cause specific mortality estimates envelope by age and sex Estimating (Total) Mortality at WHO Life tables

  5. Vaccine-Preventable Diseases: 24%

  6. Causes of 4.1 M Child Deaths, 2002

  7. Proportional Mortality Approaches

  8. Natural History Approaches

  9. Primary data Validation Sensitivity analysis Looking at all the sources of data Method 1 Best estimate Method 2 Method 3

  10. General Approach • Get best data/information (literature/grey literature review) • Primary data • Secondary data • Seek expert advise/opinion • natural history of the disease • methods/models • context • Develop consultative process with ROs/countries • Develop best methods/models • Use best assumptions/probabilities • Conduct sensitivity analysis • Validate/check consistency & coherence • Document (explicit & transparent) • Subject to in-house review, then expert review

  11. Expected Outputs • Burden of Disease Estimates • By country, age group, sex, year • With estimates of uncertainty, document methods • Country consultation, continuous update of inputs (?!?) • "Scenarios" (aka Comparing Strategies) • Recommendations for best practice • Tools for use at country level • Provide support to advocacy efforts • Cost-Effectiveness • Tools and guidelines, training, support

  12. Publish methods, database Of results, inputs Country clearance HQ produces burden of disease estimates Simultaneous Update annually Develop scenario models And database of inputs Develop costing tools and guidelines Publish tools Country Requests CEA assistance Targeted Country for Field-testing or Evaluation Publish tools IF! Collaborate with country On CEA

  13. GAVI and the Vaccine Fund • 75 out of 192 member states with GNI <$1000 eligible for support • Immunization Systems Strengthening (ISS) support –performance/reward based system • New Vaccine Support (NVS) – vaccine provided for 1st five years • "Next Window" – 2005-2009 • ICF (Investment Case Framework)

  14. The ADIP Paradigm

  15. The Example: Measles • Need to develop a method for estimating measles mortality and morbidity • Measure progress towards Measles Mortality Reduction Goal (50% reduction in measles deaths from 1999-2005) • Evaluate the impact of supplemental immunization activities (SIA’s) and routine coverage • Develop a tool for countries to use to estimate their own disease burden and monitor progress

  16. "Current" Burden of Measles

  17. CFR Literature Review

  18. 869,000 in 1999 to 610,000 in 2002

  19. Measles: Comparing Vaccination Strategies in 35 African Countries, 2005-2015

  20. SIR Model for 192 Member States

  21. How to calculate R0?

  22. Looking at Scenarios

  23. Work that is needed (urgently!!) High Priority/Some Work Started • Pneumococcal Disease (Meningitis, Pneumonia) • Rotavirus • Yellow Fever • Rubella/CRS • Diphtheria Lower Priority/Not Started • Meningoccocus A/C • Japanese Encephalitis • Mumps • Dengue • Typhoid • Cholera • ETEC • Papillomavirus • RSV • Shigella • Streptococcus group A • Infant TB

  24. CEA

  25. Data Collected by the Global Monitoring System (VAM)

  26. Mixed Bag of Needs • Simple tools for use in country to make policy decisions – but validated compared to complex methods. • Valid assessments of current burden of disease (MDG!!) • Guidance on plugging "data holes" • Introduction of new vaccines

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