Vaccine Cost Research Articles

Heterogeneous joint vaccine allocation and quarantine restriction planning under uncertainty: The COVID-19 pandemic

Once effective vaccines are discovered for a pandemic and initial distribution infrastructure, and mechanisms are implemented, the next concern is an optimal vaccination campaign to stop the disease or minimize the casualties. This paper studies the optimization of a Vaccine Distribution Network (VDN) through a single-objective Mixed-Integer Non-Linear Programming (MINLP) model for minimizing the total cost in terms of governmental aid (to maintain the economy), logistics, vaccination, and hospitalization costs. The proposed model develops the optimal joint vaccination-quarantine strategy under equity considerations to (1) determine the optimal allocation of available vaccine stockpiles to different population classes in different regions and (2) seek to impose quarantine restrictions to different regions optimally. The proposed model was applied to a real case study, the vaccine distribution network in France. Through a comprehensive numerical analysis, the optimal vaccine allocation is calculated, and the impact of equity and quarantine on the performance of the distribution network is investigated. Moreover, fractional dosing on the number of infections is examined. The results show that equity considerations, counter-intuitively, lead to an increased number of infections. Furthermore, it is illustrated that fractional dosing helps policymakers to control the pandemic better under a limited supply of vaccines.

Cost-Effectiveness of Adjuvanted Quadrivalent Influenza Vaccine for Adults over 65 in France.

In France, influenza accounts for an average of over one million consultations with GPs, 20,000 hospitalizations, and 9000 deaths per year, particularly among the over-65s. This study evaluates the cost-effectiveness of the adjuvanted quadrivalent influenza vaccine (aQIV) compared to standard (SD-QIV) and high-dose (HD-QIV) quadrivalent influenza vaccines for individuals aged 65 and older in France. The age-structured SEIR transmission model, calibrated to simulate a mean influenza season, incorporates a contact matrix to estimate intergroup contact rates. Epidemiological, economic, and utility outcomes are evaluated. Vaccine effectiveness and costs are derived from literature and national insurance data. Quality of life adjustments for influenza attack rates and hospitalizations are applied. Deterministic and probabilistic analyses are also conducted. Compared to SD-QIV, aQIV demonstrates substantial reductions in healthcare utilization and mortality, avoiding 89,485 GP consultations, 2144 hospitalizations, and preventing 1611 deaths. Despite an investment of EUR 110 million, aQIV yields a net saving of EUR 14 million in healthcare spending. Compared to HD-QIV, aQIV saves 62 million euros on vaccination costs. Cost-effectiveness analysis reveals an incremental cost-effectiveness ratio of EUR 7062 per QALY. This study highlights the cost-effectiveness of aQIV versus SD-QIV and HD-QIV, preventing influenza cases, hospitalizations, and deaths.

Can I Afford to Be on Campus? Do College Students with Disabilities Understand COVID-19 Vaccination Costs?

ABSTRACT Higher education institutions have mandated COVID-19 vaccinations for students wishing to return to an on-campus, in-person learning experience. However, college students with disabilities (SWDs) may be hesitant to take a COVID-19 vaccine for a variety of reasons, possibly delaying or denying these students’ access to higher education. Yet, an under-researched aspect of COVID-19 vaccinations and related communication is whether college students with disabilities understand that the COVID-19 vaccine is free and whether that understanding varies by intersectional identities. As a result, this study’s research team surveyed 245 college students with disabilities to explore these students’ knowledge of vaccine costs and whether differences exist between groups. Data suggests many college students with disabilities do not know that COVID-19 vaccinations are free: White/Caucasian SWDs were most aware of COVID-19 vaccines being free (23.6%), while Latinx students were least aware (1.3%). Moreover, women were more aware of free COVID-19 vaccines (14.8%) than men (11.4%), first generation college students were more aware (15.6%) than non-first generation college students (12.2%), and full-time students (19%) were more aware than part-time students (8.9%). Overall, less than 25% of SWDs understood that COVID-19 vaccines are free. Implications for health communication, vaccine awareness, and education policy are addressed.

Acceptability of a Future HIV Vaccine: A Rapid Scoping Review.

A HIV vaccine is not available yet, but perceptions of HIV vaccines will be important to explore before their roll-out for effective vaccine promotion. This article presents the findings of a rapid scoping review of the literature to identify individual, social, and vaccine-related factors associated with the acceptability of a future HIV vaccine. We searched 5 databases (Medline OVID, Embase, PsycINFO, Web of Science, and Cochrane) using relevant keywords and Medical Subject Headings. All articles, regardless of study design, publication year, and geographic location, were included if they examined HIV vaccine acceptability and its underlying factors. We retrieved 2386 unique articles, of which 76 were included in the final review. Perceived benefits (34.2%) and perceived susceptibility (25.0%) were primary individual factors of HIV vaccine acceptability. Misinformation (17.1%) and distrust (22.4%) regarding future HIV vaccines, HIV stigma (30.3%), and social support (10.5%) were social factors of HIV vaccine acceptability. Vaccine efficacy (42.1%), cost (28.9%), and side effects (67.1%) were common vaccine characteristics influencing HIV vaccine acceptability. Altruism (10.5%) and risk compensation (26.3%) were also key factors. Our analyses revealed that skeptical beliefs, negative perceptions, and misconceptions about HIV vaccines are real barriers to their acceptability. To alleviate HIV vaccine hesitancy and address trust concerns, strategic vaccine communication should be disseminated by trustworthy sources. Messages should impart accurate vaccine information and emphasize both individual and social benefits of HIV vaccination, as well as leverage social support in increasing willingness to get a future HIV vaccine.

"I'll take them another day": A qualitative study exploring the socio-behavioral complexities of childhood vaccination in urban poor settlements.

Despite improvement over recent decades, childhood vaccination uptake remains a concern across countries. The World Health Organization observed that over 25 million children missed out on one or more vaccines in 2021, with urban poor and other marginalized groups being the most affected. Given the higher risk of disease transmission and vaccine-preventable diseases (VPD) outbreaks across densely populated urban slums, identifying effective interventions to improve childhood vaccination in this vulnerable population is crucial. This study explored the behavioral and social factors influencing childhood vaccination uptake in urban informal settlements in Nairobi, Kenya. A grounded theory approach was employed to develop a theoretical account of the socio-behavioral determinants of childhood vaccination. Five focus group discussions (FGDs) were conducted with purposively sampled caregivers of children under five years of age residing in informal settlements. The Theory of Planned Behavior guided the structuring of the FGD questions. An iterative process was used to analyze and identify emerging themes. Thirty-nine caregivers (median age 29 years) participated in the FGDs. From the analysis, four main thematic categories were derived. These included attitude factors such as perceived vaccine benefits, cultural beliefs, and emotional factors including parental love. Additionally, subjective norms, like fear of social judgment, and perceived behavioral control factors, such as self-control and gender-based influences, were identified. Furthermore, a number of practical factors, including the cost of vaccines and healthcare providers attitude, also affected the uptake of vaccination. Various social, behavioral, cultural, and contextual factors influence caregiver vaccination decisions in urban poor settings. Community-derived and context-specific approaches that address the complex interaction between socio-behavioral and other contextual factors need to be tested and applied to improve the timely uptake of childhood vaccinations among marginalized populations.

Determinants of Parental Attitudes towards Children's Vaccination in Lithuania: An Online Survey.

Data from recent years show that the COVID-19 pandemic has significantly reduced the scope of child immunisation worldwide. If the numbers continue to fall, we may have a vaccination crisis. In order to understand the local factors of this phenomenon, we studied parents' viewpoint towards childhood vaccination in Lithuania. Therefore, the aim of our study was to determine the impact of parental attitudes on children's vaccination. A web-based cross-sectional study was made in Lithuania from October 20th to November 3rd, 2020, using Google Forms. An anonymous questionnaire included both quantitative and qualitative questions. The questionnaire was distributed to the general population in Lithuania via social media and a snowball sampling. Only parents who have at least one child under 18 years old were involved in the study. We analysed the parents' attitudes towards vaccination by their socioeconomic and demographic determinants using MS Excel and OpenEpi tools. The respondents were considered vaccine supporters if they vaccinated all their children with state-reimbursed vaccines or only vaccinated some of their children, and vaccine sceptics if they did not vaccinate their children with state-reimbursed vaccines. The population of our research consisted of 775 parents. There were more males against vaccination than females, respectively, 59.6% and 33.2%. 65.0% of all respondents stated that they vaccinated their children with the full course of vaccines, while the remaining 35.0% did not vaccinate. University-level education dominated in both pro-vaccine and anti-vaccine groups. We found that 16.9% of parents who were unvaccinated as children themselves tend not to vaccinate their children. However, in the pro-vaxx group, only 0.7% of parents were unvaccinated during childhood. 50.8% of vaccine sceptics were not fully informed by healthcare professionals about the benefits and risks of vaccination, while only 31.6% of vaccine supporters were not informed. Social environment did not have an impact on the decision whether to vaccinate or not to vaccinate a child among both vaccine advocates and vaccine deniers (accordingly, 51.2% and 42.9%). 29.3% of respondents stated that the cost of paid vaccinations was too high. Open-text survey responses gave us more in-depth insight about the parental decision-making process. Protection of children and society from infectious diseases (31.7%) was mentioned as the main reason for vaccination. Whereas vaccine-hesitant parents were mostly concerned about already-occurring side effects or their risk (43.4%). Our findings confirmed that vaccine hesitancy was associated with not being vaccinated in childhood themselves, lack of information from medical practitioners and male gender. The price of vaccines also had an impact on immunisation rates - more than one-third of the vaccine supporting parents indicated that the cost of paid vaccinations was too high. The main incentive for vaccine compliance was parents' desire to protect their children and society from infectious diseases. Whereas vaccine-hesitant parents were mostly concerned about already occurring side effects or their risk. There was no consensus, whether vaccination of children should be mandatory in Lithuania, as the answers to the question were almost evenly distributed. The formation of parents' attitudes towards children's vaccination is a complex process that is determined by parents' attitudes towards the health care system, lack of trust in doctors, and gaps in communication about the benefits and risks of vaccination. All of this information should be taken into account in health policy-making.

Benefit–Cost Analysis of the HHS COVID-19 Campaign: April 2021–March 2022

This study estimated the benefits and costs of the U.S. Department of Health and Human Services' We Can Do This COVID-19 public education campaign (the Campaign) and associated vaccination-related impacts. Weekly media market and national Campaign expenditures were used to estimate weekly first-dose vaccinations that would not have occurred absent the Campaign, weekly Campaign-attributed complete vaccinations, and corresponding COVID-19 cases, hospitalizations, and deaths averted. Benefits were valued using estimated morbidity and mortality reductions and associated values of a statistical life and a statistical case. Costs were estimated using Campaign paid media expenditures and corresponding vaccination costs. The net Campaign and vaccination benefit and return on investment were calculated. Analyses were conducted from 2022 to 2024. Between April 2021 and March 2022, an estimated 55.9 million doses of COVID-19 vaccines would not have been administered absent the Campaign. Campaign-attributed vaccinations resulted in 2,576,133 fewer mild COVID-19 cases, 243,979 fewer nonfatal COVID-19 hospitalizations, and 51,675 lives saved from COVID-19. The total Campaign benefit was $740.2 billion, and Campaign and vaccination costs totaled $8.3 billion, with net benefits of approximately $732.0 billion. For every $1 spent, the Campaign and corresponding vaccination costs resulted in benefits of approximately $89.54. The We Can Do This COVID-19 public education campaign saved more than 50,000 lives and prevented hundreds of thousands of hospitalizations and millions of COVID-19 cases, representing hundreds of billions of dollars in benefits in less than one year. Findings suggest that public education campaigns are a cost-effective approach to reducing COVID-19 morbidity and mortality.

Cost-Effectiveness of 20-Valent Pneumococcal Conjugate Vaccine in Argentinean Adults.

In Argentina, vaccination with 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23; PCV13 → PPSV23) has been recommended for all adults aged ≥ 65 years and younger adults with chronic medical ("moderate-risk") or immunocompromising ("high-risk") conditions since 2017. With the approval of a 20-valent PCV (PCV20), we evaluated the cost-effectiveness of PCV20 versus current recommendations for moderate-/high-risk adults aged 18-64 years and all adults 65-99 years. A probabilistic cohort model was used to project lifetime outcomes and costs associated with invasive pneumococcal disease (IPD) and all-cause non-bacteremic pneumonia (NBP), and the expected impact of vaccination. Clinical outcomes were projected annually based on Argentinean data. Economic costs were estimated based on cases and corresponding medical costs (adjusted to 2023 USD) and costs of vaccine and administration. Cost-effectiveness of PCV20 was evaluated versus the current strategy, PCV13 → PPSV23, and alternatively, versus sequentially administered 15-valent PCV and PPSV23 (PCV15 → PPSV23), and presented as cost per quality-adjusted life year gained; a healthcare system perspective was used. Costs and benefits were discounted at 3%/year. PCV20 in lieu of PCV13 → PPSV23 among moderate-/high-risk adults aged 18-64 years and all adults 65-99 years (N = 13.4M) prevented 3838 IPD, 4377 inpatient NBP, and 6003 outpatient NBP cases, and 1865 disease-related deaths; relative to PCV15 → PPSV23 the corresponding reductions were 2775, 3285, 4518, and 1348. PCV20 was projected to be the dominant strategy versus PCV13 → PPSV23 and PCV15 → PPSV23 as overall costs were lower by $87.6M and $80.8M, respectively. In probabilistic sensitivity analyses, PCV20 was dominant (i.e., more effective, less costly) in 100% of 1000 simulations. Analyses suggest implementing a PCV20 vaccination program in moderate-/high-risk adults aged 18-64 years and all adults ≥ 65 years-in lieu of PCV13 → PPSV23-would yield substantial reductions in pneumococcal disease and would be cost saving to the Argentinean healthcare system.

Changing rules, recommendations, and risks: COVID-19 vaccination decisions and emotions during pregnancy

As COVID-19 vaccinations rolled out globally from late 2020, rules and recommendations regarding vaccine use in pregnancy shifted rapidly. Pre-registration COVID-19 vaccine trials excluded those who were pregnant. Initial Australian medical advice did not routinely recommend COVID-19 vaccines in pregnancy, due to limited safety data and little perceived risk of local transmission. Advice from local medical authorities changed throughout 2021, however, with recommendations and priority access during pregnancy. In Western Australia (WA), recommendations became requirements as the State government mandated vaccines for some workers, with brief availability of pregnancy exemptions. Through an examination of 10 in-depth interviews with WA pregnant women, we explore their decision-making and complex emotions regarding COVID-19 vaccinations, and how they balanced mandates, recommendations, and shifting considerations and perceptions of risk. Changing recommendations and rules—and media and popular interpretation and communications of these—led to confusion, including for medical professionals. Expectant parents had to negotiate the risks of COVID-19 disease, potential benefits and risks of vaccination, professional and personal costs of vaccine refusal, and interpret mixed medical advice. Our findings can inform the development and communication of public health policies and medical advice, and contribute to our understanding of bodily autonomy, risk, and decision-making beyond the pandemic.

Production Elasticity of Layer Farming During the COVID-19 Pandemic in Blitar District

The livestock sub-sector, an integral part of the agricultural sector, is the animal protein producing sub-sector which plays an important role in meeting people's nutritional needs. The development of the laying hen farming business has enormous potential, this is because purebred chicken eggs contribute quite a lot to animal protein self-sufficiency. The research aims to analyze the input factors of the production that affect the production of layer farming businesses and to assess the production elasticity of these businesses during the COVID-19 pandemic in Blitar District. Data collection took place between July and August 2020 in the Blitar Distrcit. Utilizing a sample random sampling method. The study involved 64 farmers as representative. The research variables used in this study were the population of laying hens, the price of chicken eggs, feed costs, vaccines and medicines expenses, seed prices, mortality, electricity costs, the price of culled chickens, Hen Day Production (HDP) and the number of workers. Quantitative analysis was employed to analyze production costs, revenues, and income, while qualitative analysis was used to analyze production elasticity through Cobb-Douglas regression analysis. The research data were processed using SPSS version 24. The results of the study indicate that 1) the population of laying hens and HDP significantly affected the production of layer farming businesses, along with the cost of vaccines and medications in the Blitar District. 2) The population of layers, mortality rates, electricity costs, HDP, and total labor demonstrated elasticity with respect to the production of layer farms. Conversely, egg prices, feed costs, vaccination and medication expenses, day-old chick (DOC) costs, and final chicken prices exhibited inelasticity concerning the production of layer farms in Blitar district.

An immuno-epidemiological model with waning immunity after infection or vaccination

In epidemics, waning immunity is common after infection or vaccination of individuals. Immunity levels are highly heterogeneous and dynamic. This work presents an immuno-epidemiological model that captures the fundamental dynamic features of immunity acquisition and wane after infection or vaccination and analyzes mathematically its dynamical properties. The model consists of a system of first order partial differential equations, involving nonlinear integral terms and different transfer velocities. Structurally, the equation may be interpreted as a Fokker-Planck equation for a piecewise deterministic process. However, unlike the usual models, our equation involves nonlocal effects, representing the infectivity of the whole environment. This, together with the presence of different transfer velocities, makes the proved existence of a solution novel and nontrivial. In addition, the asymptotic behavior of the model is analyzed based on the obtained qualitative properties of the solution. An optimal control problem with objective function including the total number of deaths and costs of vaccination is explored. Numerical results describe the dynamic relationship between contact rates and optimal solutions. The approach can contribute to the understanding of the dynamics of immune responses at population level and may guide public health policies.

Optimal control of a multi-scale immuno-influenza A transmission model with viral load-dependent infection

Influenza A is a highly contagious respiratory illness that spreads globally and results in millions of cases worldwide. The transmission rate and mortality rate of influenza in the population are determined by the load of the influenza A virus. In this study, we have developed a multi-scale immuno-influenza model considering incomplete vaccine immunity. We have calculated the basic reproduction numbers for both immunological and epidemiological models. Additionally, we have examined the stability of the disease-free equilibrium and the existence of the endemic equilibrium at the population level. To assess the cost-effectiveness of antiviral therapy at an individual level and vaccination at a population level, we have formulated an optimal control problem. The objective of this problem is to minimize both the number of influenza cases and the cost of vaccination. To solve this optimal control problem, we have employed the Ekeland variational principle. Furthermore, we have designed a global forward and backward sweep algorithm to estimate the impact of antiviral treatment on reducing influenza transmission among humans. Our findings indicate that the use of antiviral treatment significantly reduces viral loads in individuals. However, it may also increase the potential risk at the population level. Therefore, vaccination against influenza is the most effective option from a public health perspective.

Newborn vaccination game model with potentially periodic behavior

We explore the complex dynamics of epidemics, considering the significant effects of disease transmission, newborn individuals, and mortality rate. Employing an evolutionary game theory approach, we model the vaccination aspect for newborns, incorporating potential periodic behavior. The goal is to create an engaging simulation that underscores the criticality of timely infant vaccinations. By introducing periodic elements, the game adds complexity, fostering player participation and awareness of vaccination schedules. In contrast to traditional intervention game models focused on adult vaccine behavior, our approach recognizes the unique challenges posed by newborn vaccination. We address the limitations of existing models by developing a generalized compartmental model, accommodating infection duration distribution, and accurately capturing both periodic and non-periodic disease trajectories. The results show that higher efficacy in a newborn vaccine program can potentially eradicate the disease, but higher effectiveness and cost may deter vaccination. Increased motivation cost boosts vaccination rates without impacting epidemic size, whereas lower costs stabilize vaccination rates. Lower vaccine costs call for increased government investment to counter hesitancy. However, reduced efficacy and lower motivation lead to higher Vaccine Fear Scores, discouraging participation. Our work also offers a unique perspective on the dilemma of newborn vaccination, providing solutions with closed-form expressions that may exhibit periodic or non-periodic behavior. This approach facilitates disease modelers in exploring the potential periodicity of newborn vaccination programs, aiding efforts to prevent recurrent outbreaks.

Academia and society should join forces to make anti-cancer treatments more affordable.

Discovery research is the starting point for the development of more effective anti-cancer treatments. It requires an interdisciplinary research environment with first-class infrastructural support in which curiosity-driven research can lead to new concepts for treating cancer. Translating such research findings to clinical practice requires complementary skills and infrastructures, including high-quality clinical facilities, access to patient cohorts and participation of pharma. This complex ecosystem has yielded many new but also "me too" treatment regimens, especially in immuno-oncology resulting in an extremely high pricing of anti-cancer agents. The costs of antibodies, vaccines, and cell therapies charged by pharma stand out although the concepts and methodologies have been largely developed in academia, financed from public funds. Comprehensive Cancer Centres (CCCs) covering a coherent stretch of the cancer research continuum are well-positioned to make these personalized treatments more affordable, but this will require restructuring of the way the translational cancer research continuum is funded.

Factors influencing Thai university students’ decisions to take COVID-19 vaccine booster doses: a cross-sectional survey

BackgroundWe aimed to describe the acceptance of COVID-19 vaccine booster doses and factors influencing this among Thai university students.MethodsA cross-sectional survey was conducted between July and September 2022. All university students in Thailand were eligible to participate. We explored the acceptance rate of COVID-19 vaccine booster doses and regular vaccines (if available) among university students. Associations between factors influencing the acceptance of vaccination were analyzed by multiple logistic regression analysis.ResultsA total of 322 participants were surveyed (78.9% female, age 18 to 49 years (mean = 22.6, standard deviation = 5.47)). Most participants (85.7%) were undergraduate students (Bachelor level), and a proportion (84.8%) had a background in health sciences studies. The proportions who accepted booster doses and regular vaccines were 52.8% and 69.3%, respectively. Vaccine accessibility was found to be significantly associated with the acceptance of booster doses (adjusted odds ratio (AOR) = 2.77, 95% confidence interval (CI) = 1.10–6.97), while the availability of scientific evidence (AOR = 3.44, 95% CI = 1.21–9.77) was significantly associated with the acceptance of regular vaccines.ConclusionsThis study contributes to addressing the knowledge gap regarding acceptance of COVID-19 vaccine booster doses among university students in Thailand. Our findings revealed that vaccine accessibility and the availability of scientific evidence, as well as vaccination costs, influenced individuals’ decisions around accepting vaccine booster doses. Further research should focus on the dynamics of vaccine acceptance to facilitate the development of targeted strategies and support vaccination policymaking in Thailand.

Perceptions, Attitudes, and Barriers to Human Papillomavirus Vaccination Among Residents in Saudi Arabia: A Cross-Sectional Study.

Human papillomavirus (HPV) infection is a prevalent sexually transmitted infection globally, with significant associations with various cancers. Despite the availability of HPV vaccines, vaccination uptake remains suboptimal in many regions, including Saudi Arabia. This cross-sectional survey-based study aimed to assess perceptions, attitudes, and barriers related to HPV vaccination among residents in different regions of Saudi Arabia. Participants were recruited using a stratified sampling method, and data were collected through a structured questionnaire administered electronically. A total of 600 participants were included in the study, with diverse demographic profiles observed. The largest age group was 26-35 years old, comprising 42.7% (n = 256) of the sample. The distribution of gender was approximately equal, with 54.7% (n = 328) male participants. Notable perception and knowledge about HPV were observed, with 49.7% (n = 298) reporting being very familiar. Furthermore, 85.8% (n = 515) believed that HPV could cause serious health problems, and 63.7% (n = 382) perceived the vaccine to be very effective. Positive attitudes toward HPV vaccination were prevalent, with a significant proportion expressing a willingness to recommend the vaccine to themselves (70.0%, n = 420) and their children (65.0%, n = 390). Healthcare provider recommendation emerged as a key influencing factor, with 73.8% (n = 443) citing it as influential. Despite favorable attitudes, barriers to HPV vaccination were reported, including vaccine cost (22.5%, n = 135) and lack of awareness (13.7%, n = 82). However, a substantial proportion of unvaccinated participants cited not applicable reasons (57.2%, n = 343), indicating prior vaccination. Factors associated with HPV vaccination uptake included higher education levels, with those holding a master's degree or above exhibiting higher odds of vaccination uptake (OR (odds ratio): 1.80, 95% CI (confidence interval): 1.35-2.40, p < 0.001). Age (26-35 vs. 18-25) also showed a borderline significant association (OR: 1.25, 95% CI: 0.98-1.60, p = 0.074). The study highlights the importance of understanding perceptions and barriers to HPV vaccination to inform public health policies and programs in Saudi Arabia. Addressing identified barriers, such as educational campaigns and improving access to vaccination services, is essential for enhancing HPV vaccination coverage and reducing the burden of HPV-related diseases in the region.

An evaluation of the cost of human papilloma virus (HPV) vaccine delivery in Zambia

BackgroundHuman papillomavirus (HPV) is a common sexually transmitted infection and the leading cause of cervical cancer. The HPV vaccine is a safe and effective way to prevent HPV infection. In Zambia, the vaccine is given during Child Health Week to girls aged 14 years who are in and out of school in two doses over two years. The focus of this evaluation was to establish the cost to administer a single dose of the vaccine as well as for full immunisation of two doses.MethodsThis work was part of a broader study on assessing HPV programme implementation in Zambia. For HPV costing aspect of the study, with a healthcare provider perspective and reference year of 2020, both top-down and micro-costing approaches were used for financial costing, depending on the cost data source, and economic costs were gathered as secondary data from Expanded Programme for Immunisation Costing and Financing Project (EPIC), except human resource costs which were gathered as primary data using existing Ministry of Health salary scales and reported time spent by different health cadres on activities related to HPV vaccination. Data was collected from eight districts in four provinces, mainly using a structured questionnaire, document reviews and key informant interviews with staff at national, provincial, district and health facility levels. Administrative coverage rates were obtained for each district.ResultsFindings show that schools made up 53.3% of vaccination sites, community outreach sites 30.9% and finally health facilities 15.8%. In terms of coverage for 2020, for the eight districts sampled, schools had the highest coverage at 96.0%. Community outreach sites were at 6.0% of the coverage and health facilities accounted for only 1.0% of the coverage. School based delivery had the lowest economic cost at USD13.2 per dose and USD 28.1 per fully immunised child (FIC). Overall financial costs for school based delivery were US$6.0 per dose and US$12.4 per FIC. Overall economic costs taking all delivery models into account were US$23.0 per dose and US$47.6 per FIC. The main financial cost drivers were microplanning, supplies, service delivery/outreach and vaccine co-financing; while the main economic cost drivers were human resources, building overhead and vehicles. Nurses, environmental health technicians and community-based volunteers spent the most time on HPV related vaccination activities compared to other cadres and represented the greatest human resource costs.ConclusionsThe financial cost of HPV vaccination in Zambia aligns favourably with similar studies conducted in other countries. However, the economic costs appear significantly higher than those observed in most international studies. This discrepancy underscores the substantial strain placed on healthcare resources by the program, a burden that often remains obscured. While the vaccine costs are currently subsidized through the generous support of Gavi, the Vaccine Alliance, it’s crucial to recognize that these expenses pose a considerable threat to long-term sustainability. Consequently, countries such as Zambia must proactively devise strategies to address this challenge.

Imperfect Vaccination Evolutionary Game Incorporating Individual Social Difference and Subjective Perception

Previous studies have focused on the assumption that individual attitudes toward epidemics, epidemic-related information, and vaccination are identical with much less effort attempting to consider psychological factors and individual heterogeneity. In this article, we employ a two-layer susceptible–infected–recovered–vaccinated/unaware–aware–unaware (SIRV-UAU) coupled network to depict the interplay between epidemic spreading and information diffusion. We propose an imperfect vaccination evolutionary game model integrating prospect theory (PT) to explore the effect of individual subjective perception and social difference on epidemic spreading and vaccination equilibrium. We find that the individual social difference in the epidemic spreading layer has a more significant impact on the epidemic threshold than that in the information diffusion layer. Individual psychological perception and vaccination behavior decision-making determine the vaccination equilibrium: under the PT, vaccination equilibrium increases with the decrease of the rationality coefficient when the vaccination cost is small. Furthermore, we analyze the effect of social differences on individual vaccination behavior decision-making and find that vaccination equilibrium increases with the increase of social reinforcement strength and primary protective probability. Finally, we discuss the effect of infection cost on vaccination equilibrium when the infection cost of vaccinated individuals is less than that of unvaccinated individuals and observe that a small infection cost helps improve the vaccination equilibrium.

Mixed methods to evaluate knowledge, attitudes and practices (KAP) towards rabies in central and remote communities of Moramanga district, Madagascar.

Control of dog-mediated rabies relies on raising awareness, access to post-exposure prophylaxis (PEP) and mass dog vaccination. To assess rabies awareness in Moramanga district, Madagascar, where rabies is endemic, two complementary quantitative and qualitative approaches were carried out in 2018. In the quantitative approach, a standardized questionnaire was administered to 334 randomized participants living in 170 households located less than 5 km from the anti-rabies treatment center (ARTC) located in Moramanga city (thereafter called the central area), and in 164 households located more than 15 km away from the ARTC in two rural communes (thereafter called the remote area). Logistic regression models were fitted to identify factors influencing knowledge and practice scores. The qualitative approach consisted in semi-structured interviews conducted with 28 bite victims who had consulted the ARTC, three owners of biting dogs, three ARTC staff and two local authorities. Overall, 15.6% (52/334) of households owned at least one dog. The dog-to-human ratio was 1:17.6. The central area had a significantly higher dog bite incidence (0.53 per 100 person-years, 95% CI: 0.31-0.85) compared to the remote area (0.22 per 100 person-years, 95% CI: 0.09-0.43) (p = 0.03). The care pathway following a bite depended on wound severity, how the dog was perceived and its owner's willingness to cover costs. Rabies vaccination coverage in dogs in the remote area was extremely low (2.4%). Respondents knew that vaccination prevented animal rabies but owners considered that their own dogs were harmless and cited access and cost of vaccine as main barriers. Most respondents were not aware of the existence of the ARTC (85.3%), did not know the importance of timely access to PEP (92.2%) or that biting dogs should be isolated (89.5%) and monitored. Good knowledge scores were significantly associated with having a higher socio-economic status (OR = 2.08, CI = 1.33-3.26) and living in central area (OR = 1.91, CI = 1.22-3.00). Good practice scores were significantly associated with living in central area (OR = 4.78, CI = 2.98-7.77) and being aware of the ARTC's existence (OR = 2.29, CI = 1.14-4.80). In Madagascar, knowledge on rabies was disparate with important gaps on PEP and animal management. Awareness campaigns should inform communities (i) on the importance of seeking PEP as soon as possible after an exposure, whatever the severity of the wound and the type of biting dog who caused it, and (ii) on the existence and location of ARTCs where free-of-charge PEP is available. They should also encourage owners to isolate and monitor the health of biting dogs. Above all, awareness and dog vaccination campaigns should be designed so as to reach the more vulnerable remote rural populations as knowledge, good practices and vaccination coverage were lower in these areas. They should also target households with a lower socio-economic status. If awareness campaigns are likely to succeed in improving access to ARTCs in Madagascar, their impact on prompting dog owners to vaccinate their own dogs seems more uncertain given the financial and access barriers. Therefore, to reach the 70% dog vaccination coverage goal targeted in rabies elimination programs, awareness campaigns must be combined with free-of-charge mass dog vaccination.

Optimal Social and Vaccination Control in the SVIR Epidemic Model

In this paper, we introduce an approach to the management of infectious disease diffusion through the formulation of a controlled compartmental SVIR (susceptible–vaccinated–infected–recovered) model. We consider a cost functional encompassing three distinct yet interconnected dimensions: the social cost, the disease cost, and the vaccination cost. The proposed model addresses the pressing need for optimized strategies in disease containment, incorporating both social control measures and vaccination campaigns. Through the utilization of advanced control theory, we identify optimal control strategies that mitigate disease proliferation while considering the inherent trade-offs among social interventions and vaccination efforts. Finally, we present the results from a simulation-based study employing a numerical implementation of the optimally controlled system through the forward–backward sweep algorithm. The baseline model considered incorporates parameters representative of typical values observed during the recent pandemic outbreak.