Abstract
Given global Coronavirus Disease 2019 (COVID-19) vaccine shortages and inequity of vaccine distributions, fractionation of vaccine doses might be an effective strategy for reducing public health and economic burden, notwithstanding the emergence of new variants of concern. In this study, we developed a multi-scale model incorporating population-level transmission and individual-level vaccination to estimate the costs of hospitalization and vaccination and the economic benefits of reducing COVID-19 deaths due to dose-fractionation strategies in India. We used large-scale survey data of the willingness to pay together with data of vaccine and hospital admission costs to build the model. We found that fractional doses of vaccines could be an economically viable vaccination strategy compared to alternatives of either full-dose vaccination or no vaccination. Dose-sparing strategies could save a large number of lives, even with the emergence of new variants with higher transmissibility.
Highlights
Given global vaccine shortages and inequity of vaccine distributions, fractionation of vaccine doses might be an effective strategy for reducing public health and economic burden, notwithstanding the emergence of COVID-19 variants
Our analysis suggests that dose fractionation of vaccines is a cost-effective strategy for mitigating the COVID-19 pandemic and could reduce a large number of deaths in LMICs
In our economic calculations, we mainly considered the expense of vaccines in the private sector[29] and hospitalization costs in private hospitals[30]
Summary
Given global vaccine shortages and inequity of vaccine distributions, fractionation of vaccine doses might be an effective strategy for reducing public health and economic burden, notwithstanding the emergence of COVID-19 variants. Our analysis suggests that dose fractionation of vaccines is a cost-effective strategy for mitigating the COVID-19 pandemic and could reduce a large number of deaths in LMICs. Fractional doses of vaccines will accelerate population coverage and, thereby, augment responsive capacity in managing new SARS-CoV-2 variants with increased transmissibility or immune escape potential. Our study considers the vaccine efficacy of a full dose against infection ranging from 52% to 72%, which might overestimate some vaccines used in India, especially for new variants To account for these uncertainties, we provided comprehensive sensitivity analyses by changing basic assumptions, including the initial simulation conditions, vaccine efficacy against infection and the dosing strategy Online content Any methods, additional references, Nature Research reporting summaries, source data, extended data, supplementary information, acknowledgements, peer review information; details of author contributions and competing interests; and statements of data and code availability are available at https://doi.org/10.1038/ s41591-022-01736-z
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