Benefit-Cost Ratios of Continuing Routine Immunization During the COVID-19 Pandemic in Africa

Elizabeth Watts,Joshua Mak,Bryan Patenaude

doi:10.1017/bca.2021.13

Elizabeth Watts, Joshua Mak + Show 1 more

Open Access

https://doi.org/10.1017/bca.2021.13

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Abstract

AbstractDisruptions in routine immunization caused by COVID-19 put African countries with large vaccine-preventable disease burdens at high risk of outbreaks. Abbas et al. (2020) showed that mortality reduction from resuming immunization outweighs excess mortality from COVID-19 caused by exposure during immunization activities. We leverage these estimates to calculate benefit-cost ratios (BCRs) of disrupted immunization and apply cost of illness (COI) and value of statistical life-year (VSLY) approaches to estimate the cost of excess child deaths from eight vaccine-preventable diseases. BCRs were computed for each country, vaccine, and Expanded Program on Immunization visit. Secondary estimates that include the cost of providing immunization are presented in scenario analysis. Suspended immunization may cost $4949 million due to excess mortality using the COI approach, or $34,344 million using the VSLY approach. Likewise, excess COVID-19 deaths caused by exposure from immunization activities would cost $53 and $275 million using the COI and VSLY approaches, respectively. BCRs of continuing routine immunization are 94:1 using COI and 125:1 using VSLY, indicating that the economic costs of suspending immunization exceed that of COVID-19 deaths risked by routine immunization. When including the costs of providing routine immunization during the COVID-19 pandemic, the BCRs are 38:1 and 97:1 using the COI and VSLY approaches, respectively.

Highlights

Egypt’s first COVID-19 cases were reported on 14 February 2020 (World Health Organization, 2020a)
Hepatitis B, H. influenzae type b, and S. pneumoniae are designated as Expanded Program on Immunization (EPI) visit 1 (EPI-1); EPI-2 consists of rotavirus, measles first dose, rubella, N. meningitidis serogroup A (MenA), and yellow fever vaccine (YFV); EPI-3 is only for measles second dose
Using the cost of illness (COI) approach, we estimated that sustaining immunization could avert $4949 million ($4776–5480) from costs associated with vaccine-preventable child deaths in the Downloadendefrxotm5htytpesa:/r/wsw(wT.caabmlberid1g)e..oTrgr/ecaortem

Summary

Introduction

Egypt’s first COVID-19 cases were reported on 14 February 2020 (World Health Organization, 2020a). By 7 April 2020, COVID-19 cases have been detected in 52 African countries (World Health Organization, 2020a). The COVID-19 pandemic has disrupted health systems’ abilities to provide basic services worldwide (World Health Organization, 2020c). Based on a survey by the WHO conducted between May and July 2020, 50 % of responding countries have experienced disruptions to immunization services, with severe disruptions more common in low- and middle-income countries (LMICs) (World Health Organization, 2020c). Efforts to increase or maintain immunization coverage in 2020 have been thwarted by measures aimed at slowing the spread of COVID-19, such as physical distancing and travel restrictions (World Health Organization, 2020d). Disruptions in service stem from supply- and demandside factors, including supply chain disruptions, health facility closures, transportation challenges during lockdowns, and fear of contracting COVID-19 (World Health Organization, 2020c). Backslides in immunization coverage will exacerbate existing inequities in immunization coverage and disease burden (World Health Organization and UNICEF, 2020)

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