Global cooperation needed to tackle vaccine-preventable diseases in a world with COVID-19

Conventional health economics suggest LMICs should spend money on health interventions deemed cost-effective 

The authors of a commentary article published in the BML Global Health say that the COVID-19 pandemic has disrupted vaccination campaigns, threatens to increase the future vaccine-preventable disease burden and overwhelm healthcare systems.

They call for greater investment in vaccination programmes by rich countries to be operationally prioritised and distributed equitably to achieve outcomes that are in their interests too.

Lead author, Dr Itamar Megiddo of the Department of Management Science at the University of Strathclyde, said, “Many countries have halted vaccination programmes and campaigns, including for measles and polio, where vaccination has had a transformative impact on the burden of disease.

“This combined with the economic effects of the COVID-19 pandemic means future vaccine financing is unclear.

“Low- and middle-income countries (LMICs) and global funders must trade-off between increasing vaccination coverage, continuing disease elimination campaigns, and introducing new, more expensive vaccines.

“For example, if a vaccine is developed for COVID-19 without increased Development Assistance for Health funding, its deployment could also exacerbate financial pressures on health systems, hence, the burden of vaccine-preventable diseases will increase as a consequence of the current pandemic, especially in LMICs.”

Conventional health economics suggest LMICs should spend money on health interventions deemed cost-effective.

If a donor also invests funds in the most cost-effective activities, it will crowd out domestic funding as the recipient country will still not spend on cost-ineffective interventions.

The authors suggest that a donor-country (DC) model whereby the donor focuses its spending on these ‘just below cost-effectiveness’ vaccines, would result in more vaccines being funded, and bring down the cost of these interventions and help the country move towards self-sufficiency.

The researchers illustrated this by looking at Gavi, the vaccine alliance– a public-private partnership – which is the main distributor of vaccine-specific donor funding, contributing $1.52 billion in 2018 (54 per cent of donor vaccine-funding).

Its aid has helped increase vaccination coverage across the world and the Alliance aims to co-fund vaccination programmes in countries with the end goal of helping them become self-sufficient.

However, the authors note that this policy is based on rules that, though transparent, have no theoretical underpinnings and do not clearly lead to an equitable allocation. Further, financial and institutional sustainability remain challenges for many graduating countries—an issue the COVID-19 pandemic may exacerbate.

A recent study of co-financing by Gavi of diphtheria, tetanus, pertussis, and hepatitis B vaccines in Ghana and analysis of comparator countries revealed that where the DC model suggests the transition to self-sufficiency should be gradual, in practice, it seems sporadic with the proportion of Gavi’s spending fluctuating up and down.

Dr Megiddo said: “Vaccine-preventable diseases are international, cross-border issues that requires global cooperation to achieve the best outcomes.

“High-income country funding to increase vaccines’ coverage in LMICs is both indispensable and in the interest of high-income countries themselves since they can benefit from reduced infections coming into the country, helping to avoid the need for travel restrictions and associated negative economic impacts.

“Defeating the world’s vaccine-preventable diseases requires cooperation, but without fairness, cooperation cannot be sustained.

“Recent theoretic advances show why rich-poor financial transfers will be required as part of any financing solution, and also how such funds can be operationally prioritised and disbursed equitably.”

The authors also included researchers at the University of Ghana, Imperial College London, the Center for Global Development Europe, London School of Hygiene & Tropical Medicine and the University of Cambridge.

The study was funded by the UK Government and the Bill & Melinda Gates Foundation.