Vaccine Purchase Research Articles

Evaluation of commercial quadrivalent foot-and-mouth disease vaccines against east African virus strains reveals limited immunogenicity and duration of protection

Foot-and-mouth disease virus (FMDV) causes a contagious disease (FMD) in cloven-hoofed animals. For FMD-endemic countries, vaccination is critical for controlling disease but is rarely monitored, despite substantial funds spent on vaccine purchases. We evaluated antibody responses in cattle to two commercial vaccines each containing antigens of four FMDV serotypes. Sampling was done over 360 days, with serology for each serotype performed using commercially available solid phase competition ELISAs (SPCE) and with virus neutralization tests (VNT) employing regionally relevant test viruses. A primary course of each vaccine was administered to 37 calves, some of which received a second dose after 28 days. Using new production batches of vaccines, all calves received a booster vaccination 180 days post vaccination, while 10 additional naïve calves were also vaccinated using the new batches and followed up for ∼180 days. Simple and general linear models were used to compare antibody responses which varied substantially according to vaccine, dose regime, serotype, and test, but were mostly insufficient to ensure a high likelihood of adequate or sustained probable protection. One of the vaccines administered as a two-dose primary course of vaccination was superior to other options, but even then, data trajectories from VNT responses suggested probable protection of 75 % of calves for 6 months for only one virus serotype. Calves administered with the other vaccine and those given a single primary dose developed low levels of antibodies, offering predicted likely protection lasting less than two months. Individual SPCE results were weakly correlated (r2 = 0.48) to neutralization and associated likelihoods of protection but SPCE and VNT agreed on which vaccine and dose regime performed best. Our findings highlight gaps in immunogenicity of FMD vaccines used in East Africa and reinforce the importance of independent quality control studies to evaluate and improve commercial FMD vaccines and vaccination regimes.

Jurisdiction-level costs of the initial phase of the COVID-19 vaccination program in the United States, December 20, 2020–May 31, 2021

This study aimed to quantify U.S. jurisdiction-level costs related to the COVID-19 Vaccination Program by estimating the per-dose-administered cost during December 20, 2020–May 31, 2021, from a combined federal and local government perspective. Costs were limited to vaccine purchase, administration (including operations and wastage), and local redistribution by jurisdictions. Data were collected through publicly available sources, published literature, and a survey of 62 jurisdictions (38 responded). A total of 284.6 million doses of COVID-19 vaccine were distributed to jurisdictions during the study period, of which 284.2 million doses were administered, and 0.4 million doses were wasted. The estimated cost per-dose-administered among the 38 jurisdictions that responded to study survey was $57.45 and imputed cost across all jurisdictions was $63.11. The findings on jurisdiction-level cost per-dose-administered and vaccination cost during the initial period of U.S. COVID-19 Vaccination Program, when demand exceeded supply, may be considered in future pandemic preparedness planning.

A friend indeed to friends in need? China's trade regime and Covid-19 vaccine diplomacy

Employing newly available data on Chinese Covid-19 vaccine deliveries for a cross-section of 157 countries, we examine if China's vaccine diplomacy is driven by altruistic, enlightened self-interested motives or by purely strategic motives. According to the enlightened self-interested logic, China's vaccine supply would coincide with helping countries dependent on China for trade, i.e. its trading friends, while the strategic logic would entail providing vaccines to countries important commercially to China. In other words, the gravity of the Covid situation would be leveraged by China for strategic gain. Utilizing the logit estimator on probability of receiving vaccines from China and Tobit estimator on vaccine purchases and donations, we find that developing countries that are important to China's trade, and thereby, China's own commercial interests were less likely to get vaccines compared with countries that are more dependent on China. Furthermore, we find that countries more dependent on China are also likely to receive vaccine donations rather than purchases, suggesting that vaccine diplomacy was unlikely to be for commercial and strategic gain. Our results taken together signify that vaccine deliveries by China were not manipulated by trade interests in Beijing. The results suggest instead that China supplied vaccines to countries needing them and with whom Chinese goodwill reflects a more normal course of diplomacy—to service friends in need.

Cost-effectiveness analysis of COVID-19 vaccination: A review of some vaccination models

The sudden and rapid spread of the COVID_19 pandemic with its terrible consequences has put the management of governments and the various world institutions into a crisis. They have been subjected to a considerable economic effort to be taken to combat the spread of the pandemic. The economic investment for the research and purchase of vaccines intended for populations is subject to cost–benefit analyses in various situations in different cases. In this review work, several recent models are analyzed where the appearance of the components is coupled with the economic aspect. The analysis of these models is detailed and the results discussed from different points of view.

Analysis of the Federal Section 317 Immunization Program and Routine Adult Immunization Activities, United States, 2022-2023.

The federal Section 317 Immunization Program, administered by the Centers for Disease Control and Prevention (CDC), provides funding to support adult immunization efforts; however, current information on program implementation at the jurisdictional level is limited. We assessed the use of Section 317 and other funding sources to support routine adult immunization activities among the 64 immunization programs ("awardees"). We conducted a survey and key informant interviews with awardees in October to December 2022 to collect quantitative and qualitative data on current adult vaccine purchase and program operation activities funded by Section 317 and other funding sources. We assessed total vaccine cost and data on vaccine purchase projections for each awardee with CDC's Cost and Affordability Tool for 2023. Immunization program managers or their designees from 62 of 64 awardees (97%) completed the survey; 12 awardees participated in key informant interviews. Of 62 awardees, 32 (52%) used a single funding source to support adult vaccine purchases, of which 29 (91%) used only Section 317 funds, 21 (34%) reported not planning to purchase ≥1 age-based recommended vaccine for adults in 2023, and 33 (53%) reported using Section 317 funds only to support adult immunization program operations. Key informant interviews showed varied operational activities among awardees, but 8 awardees stated the need for additional staff to expand adult immunization program services in health care provider education (n = 5), program administration (n = 5), and site visits (n = 6). Additional efforts are needed to understand how to better support routine adult immunization activities implemented at the jurisdictional level.

Which foreign vaccine should the government purchase in a pandemic? Evidence from a survey experiment in the United States

BackgroundFor many countries confronting a future pandemic, the initial vaccines available will come from abroad. Public hesitancy to receive these foreign vaccines is important, as it may create an incentive for governments to forego procuring them for public use. We investigate the influence of the vaccine's country of origin on public support for government procurement during the early stages of a pandemic and examine whether endorsements from the WHO can mitigate such biases. MethodsIn the summer of 2023, we carried out a survey experiment of 1,110 U.S. residents where we asked respondents to rate their support for vaccine purchasing policies for 20 hypothetical vaccines (13,320 evaluations). We varied the vaccine's country of origin and its endorsement status from the WHO, while also randomizing other vaccine attributes. ResultsCompared to foreign vaccines from countries Americans see favorable (e.g., Germany, the United Kingdom), those originating from less favorable countries (e.g., China, Russia), garnered lower support for government procurement. Our causal mediation analysis indicates that this country-of-origin effect is primarily driven by participants' sentiments toward the vaccine. Surprisingly, WHO endorsement does little to mitigate the effect of the vaccine's country of origin. These findings are consistent across various sample subsets and considerations of vaccine quality. ConclusionOur study advances previous work on vaccine country-of-origin effects by assessing its impact on policy preferences for procuring initial vaccines from overseas (as opposed to uptake intentions), identifying a mechanism by which vaccine favoritism occurs, and documenting that neither personal disease susceptibility nor vaccine quality fully mitigates country of origin effects. We conclude by discussing why the study of “vaccine diplomacy” ought to not only include interstate dynamics governing vaccine purchasing and availability but also consider vaccine-producing countries' more general reputations.

Costs of seasonal influenza vaccine delivery in a pediatric demonstration project for children aged 6–23 months — Nakuru and Mombasa Counties, Kenya, 2019–2021

BackgroundDuring November 2019–October 2021, a pediatric influenza vaccination demonstration project was conducted in four sub-counties in Kenya. The demonstration piloted two different delivery strategies: year-round vaccination and a four-month vaccination campaign. Our objective was to compare the costs of both delivery strategies. MethodsCost data were collected using standardized questionnaires and extracted from government and project accounting records. We reported total costs and costs per vaccine dose administered by delivery strategy from the Kenyan government perspective in 2021 US$. Costs were separated into financial costs (monetary expenditures) and economic costs (financial costs plus the value of existing resources). We also separated costs by administrative level (national, regional, county, sub-county, and health facility) and program activity (advocacy and social mobilization; training; distribution, storage, and waste management; service delivery; monitoring; and supervision). ResultsThe total estimated cost of the pediatric influenza demonstration project was US$ 225,269 (financial) and US$ 326,691 (economic) for the year-round delivery strategy (30,397 vaccine doses administered), compared with US$ 214,753 (financial) and US$ 242,385 (economic) for the campaign strategy (25,404 doses administered). Vaccine purchase represented the largest proportion of costs for both strategies. Excluding vaccine purchase, the cost per dose administered was US$ 1.58 (financial) and US$ 5.84 (economic) for the year-round strategy and US$ 2.89 (financial) and US$ 4.56 (economic) for the campaign strategy. ConclusionsThe financial cost per dose was 83% higher for the campaign strategy than the year-round strategy due to larger expenditures for advocacy and social mobilization, training, and hiring of surge staff for service delivery. However, the economic cost per dose was more comparable for both strategies (year-round 22% higher than campaign), balanced by higher costs of operating equipment and monitoring activities for the year-round strategy. These delivery cost data provide real-world evidence to inform pediatric influenza vaccine introduction in Kenya.

Hierarchical Vaccine Allocation Based on Epidemiological and Behavioral Considerations.

Vaccines have proven useful in curbing contagion from new strains of the SARS-CoV-2 virus. However, equitable vaccine allocation continues to be a significant challenge worldwide, necessitating a comprehensive allocation strategy incorporating heterogeneity in epidemiological and behavioral considerations. In this paper, we present a hierarchical allocation strategy that assigns vaccines to zones and their constituent neighborhoods cost-effectively, based on their population density, susceptibility, infected count, and attitude towards vaccinations. Moreover, it includes a module that tackles vaccine shortages in certain zones by locally transferring vaccines from zones with surplus vaccines. We leverage the epidemiological, socio-demographic, and social media datasets from Chicago and Greece and their constituent community areas to show that the proposed allocation approach assigns vaccines based on the chosen criteria and captures the effects of disparate vaccine adoption rates. We conclude the paper with a lowdown on future efforts to extend this study to design models for effective public policies and vaccination strategies that curtail vaccine purchase costs.

Clinical Profile, Comorbidities, and Outcome of the Unvaccinated and Hospitalized for COVID-19 in Northern Brazil: Retrospective Cohort

Introduction: Over the course of the pandemic, COVID-19 affected health, the economy and quality of life in Brazil. The worst years for the country were the first and second. There were delays in vaccine purchases for political reasons at the time. The northern region of the country had a higher mortality rate compared to other regions, associated with local vulnerabilities and fragility of surveillance due to geographic and population characteristics.
 Objective: To investigate the clinical profile, comorbidities, and outcome of unvaccinated people hospitalized for COVID-19 in the state of Pará in 2022.
 Methods: Retrospective cohort epidemiological study, with data from the national epidemiological surveillance of acute and severe respiratory syndromes. Cases reported in 2022 with vaccinated yes or no field and completed doses were included. Only closed cases cure or death were included. We performed a chi-square test on categorical variables and a Mann-Whitney test on numerical variables. We compared vaccinated VS non-vaccinated; we performed the Odds Ratio in the significant variables. We used the SPSS 20.0 software.
 Results: The study worked with 2,634 cases of COVID-19 hospitalized in the study period, confirmed by RT-PCR (851/32.30%) and (1,784/67.70%) rapid antigen test. The lethality was (778/29.53%), and those vaccinated with two doses were (1,473/55.90%) and those unvaccinated with no dose (1,162/44.10%). Death represents p- <0.001 (HR 1.306 - CI 1.124/1.517) higher risk of the event occurring in the unvaccinated cases, followed by male sex p-0.004 (HR 1.188 - CI 1.058/1.334).
 Conclusion: The first cohort in Brazil and in the north of the country to evaluate the clinical profile, comorbidities, and outcome of COVID-19 in hospitalized patients in this Amazon region, which is a region characterized by local vulnerability factors unique to the other regions of Brazil, showed that the unvaccinated were males, younger, with fewer comorbidities, and that they were associated the deaths.

Geopolitical aspects of COVID-19 vaccines distribution

In December 2019, the Wuhan Municipal Health Commission (China) reported to the World Health Organization (WHO) a cluster of pneumonia cases with unknown aetiology in Wuhan City, Province of Hubei, China. In March 2020, WHO declared a pandemic. So began the spread of Sars-Cov-2 and the race to possible countermeasures. This article analyses the commercial relationships of the sale and purchase of vaccines as a measure of influence between different regions of the world. Taking all vaccines with a degree of global diffusion into account (Sputnik V, Russia; Sinovac, China; Sinopharm, China; Covishield, Oxford/AstraZeneca formulation, India; Johnson & Johnson, USA; Oxford/AstraZeneca, UK; Pfizer/BioNTech, USA; and Moderna, USA), the article examines the specific regions of distribution. The paper has two aims: Firstly, to understand if the vaccines’ distribution mirrors the geopolitical <i>status quo</i>. Secondly, to identify the territories potentially more capable of causing important, regional or global, geopolitical frictions. In order to do that, the article highlights regions with unipolar and multipolar geopolitical influences. Limitations and further possible developments of the work will be commented on in the conclusions.

Cost of introducing and delivering RTS,S/AS01 malaria vaccine within the malaria vaccine implementation program.

The World Health Organization (WHO) recommended widespread use of the RTS,S/AS01 (RTS,S) malaria vaccine among children residing in regions of moderate to high malaria transmission. This recommendation is informed by RTS,S evidence, including findings from the pilot rollout of the vaccine in Ghana, Kenya, and Malawi. This study estimates the incremental costs of introducing and delivering the malaria vaccine within routine immunization programs in the context of malaria vaccine pilot introduction, to help inform decision-making. An activity-based, retrospective costing was conducted from the governments' perspective. Vaccine introduction and delivery costs supported by the donors during the pilot introduction were attributed as costs to the governments under routine implementation. Detailed resource use data were extracted from the pilot program expenditure and activity reports for 2019-2021. Primary data from representative health facilities were collected to inform recurrent operational and service delivery costs.Costs were categorized as introduction or recurrent costs. Both financial and economic costs were estimated and reported in 2020 USD. The cost of donated vaccine doses was evaluated at $2, $5 and $10 per dose and included in the economic cost estimates. Financial costs include the procurement add on costs for the donated vaccines and immunization supplies, along with other direct expenses. At a vaccine price of $5 per dose, the incremental cost per dose administered across countries ranges from $2.30 to $3.01 (financial), and $8.28 to $10.29 (economic). The non-vaccine cost of delivery ranges between $1.04 and $2.46 (financial) and $1.52 and $4.62 (economic), by country. Considering only recurrent costs, the non-vaccine cost of delivery per dose ranges between $0.29 and $0.89 (financial) and $0.59 and $2.29 (economic), by country. Introduction costs constitute between 33% and 71% of total financial costs. Commodity and procurement add-on costs are the main cost drivers of total cost across countries. Incremental resource needs for implementation are dependent on country's baseline immunization program capacity constraints. The financial costs of introducing RTS,S are comparable with costs of introducing other new vaccines. Country resource requirements for malaria vaccine introduction are most influenced by vaccine price and potential donor funding for vaccine purchases and introduction support.

Meeting the COVID-19 Pandemic: Complex Health, Socioeconomic, Gender, and Cultural Nexuses in Mexico

COVID-19 met Mexico with a fragmented healthcare system, where governmental and private corruption limited the reconstruction of hospitals after the earthquakes in 2017. Monopolies in the purchase of drugs, lack of trained medical personnel, badly equipped hospitals, obesity, and chronic diseases produced excess mortality from SARS-COV-2. Further, industrialized countries monopolized vaccines and protective gear against the pandemic and the UN-COVAX system for buying them failed. Mexico was forced to purchase vaccines worldwide at speculative prices. The country received also specialists from Cuba, purchased ventilators, trained hospital staff, and separated hospitals only for COVID-19 attention, while 145 private hospitals provided medical attention at public prices. In December 2020 first vaccines arrived and in July 2022 71.3% of the adult population was immunised. The government rejected the pressure of the International Monetary Fund for supporting big companies. Instead, direct money transfers for survival to elderlies, students, youth in apprenticeship, and peasants planting timber and fruit trees alleviated rising poverty and unemployment during the confinement. The cash for youth also moved them away from organised crime and drug production. Agreements with supermarkets and producers lowered the inflation in basic food prices and systematic increases in minimum wage improved Mexicans' purchasing power parity. Less corruption permitted the construction of new megaprojects in the poorest regions. Infrastructure in these marginalised regions recovered formal jobs, generating also labour for Central American migrants, thus reducing the political tensions on both national borders. Additionally, energy transition and subsidies of internal oil prices strengthened economic stability and the peso against the US dollar without new foreign debts. This rigorous macroeconomic policy, free vaccination, the start of a new public health system, and direct cash transfers allowed Mexico to recover in March 2022 from the 12.5 million lost jobs. The unemployment rate was in March 2023 2.4%. The complex nexuses of socioeconomic, health, youth, and gender policies promoted also an alternative social care system, reduced excess mortality and improved the living conditions of the impoverished population in the indigenous southern regions.

EE383 The Economic Burden of COVID-19 Prevention and Cases Management in Egypt from Governmental Perspective

With 2.96 trillion USD lost economic output globally in 2020 alone, COVID-19 is estimated as one of the major economical set-backs in the new era. This study aims to calculate the cost of COVID-19 management in Egypt for both prevention (represented in the vaccination program) and management including treatment protocols and indirect cost based on the figures published by the Egyptian ministry of health and population (MOHP). A retrospective excel-based cost-analysis was designed to measure direct and indirect costs of the officially recorded cases and figures only. COVID-19 cases were segmented based on severity to mild with or without hospitalization, moderate, severe, and critical considering their recorded length of stay inside the hospitals. Direct Costs were collected from governmental perspective. Indirect costs included absenteeism and premature mortality following human capital method. Death costs counted for costs of COVID-19 body bags. As per published figures, 514,088 cases and 24,723 deaths were reported, and 90,374,411 vaccine doses were administered till 30th June 2022. The total cost of COVID-19 management in Egypt was estimated to be EGP 46,049,201,088 (USD 2,454,111,899) for both prevention by vaccination, and treatment. The direct medical cost for treatment protocol by medications only was EGP 25,247,679,122 for all disease severities. Indirect costs were EGP 5,087,499,542 with (38%) due to absenteeism and (62%) due to pre-mature death. The prevention arm accounts for EGP 15,714,022,424 for vaccine purchase, storage, supply chain and administration. COVID-19 imposed a huge burden on the Egyptian healthcare system, and these costs only counted for publicly recorded cases. The real costs of the management are expected to be much higher if counting the cases recorded out of the MOHP system either due to self-management or receiving treatment in other than MOHP hospitals.

‘VaxTax’: a follow-up proposal for a global vaccine pandemic response fund

Equal access to vaccines has been one of the key ethical challenges during the COVID-19 pandemic. Most scholars consider the massive purchase and hoarding of vaccines by high-income countries, especially...

Impact of the lethal "Politics" variant on the population in Brazil.

The Covid-19 pandemic has provoked a deep and extensive health crisis and a trail of deaths globally and in Brazil (1). Brazil had reached the mark of 22,499,525 cases and 619,937 deaths by January 10, 2022 (2). The current Jair Bolsonaro government took too long to recognise the severity of the pandemic and also tried to discredit the vaccination process, and generated further controversy around the negotiations with the global suppliers. The harvest of this disastrous failure to manage the purchase and supplies of vaccines has been a hugely negative impact on the vaccination campaign, which was at a low of 22.4% in August 2021, and has only now reached 67.47% (3). There is still a long way to go to improve vaccination levels and to ensure easy access for the population (4).

Political Power and Neocolonialism of Vaccines: The Exercise of the Word and the Human Act

This paper analyzes the situation generated by the unequal distribution of vaccines that -at the international level- has occurred in the framework of the epidemic generated by COVID-19. For this, the concepts of «act» and «word» derived from the theoretical-political theses of Hannah Arendt (1993) are used, with which it was sought to evidence the situation of neocolonialism of vaccines derived from this situation, from the philosophical deconstruction to raise the urgent consequence of neocolonialism in health, which allowed us to infer how Human Rights are not the central axis of the national and state discourses or praxis of the government systems of countries with more stable and stronger economies, since the decisions and behaviors reflect the interests of the main actors of the National States that have economic support for the large-scale purchase of vaccines against COVID-19. Which in turn are the protagonists of a sociopolitical phenomenon that can be categorized as global health neocolonialism, which is presented as a phenomenon of neocolonialism that began with the confidentiality agreements signed between the States of the countries and the pharmaceutical corporations, inside or outside COVAX in the year 2020. Concluding that the massive purchase of vaccines was subject to an exclusivity character to acquire the batches, where some factors of discrimination or non-inclusion are revealed, affirming that COVAX did not comply with the purpose for what was initially created.

Which countries need COVID-19 vaccines the most? Development of a prioritisation tool

BackgroundThe COVID-19 pandemic and associated non-pharmaceutical interventions (NPIs) have affected all countries. With a scarcity of COVID-19 vaccines there has been a need to prioritize populations, but assessing relative needs has been challenging. The COVAX Facility allocates vaccines to cover 20% of each national population, followed by a needs assessment that considers five quantitative metrics alongside a qualitative assessment. The objective of this study was to identify the most important factors for assessing countries’ needs for vaccines, and to weight each, generating a scoring tool for prioritising countries.MethodsThe study was conducted between March and November 2021. The first stage involved an online Delphi survey with a purposive and snowball sample of public health experts, to reach consensus on country-level factors for assessing relative needs for COVID-19 vaccines. The second stage involved a discrete choice experiment (DCE) to determine weights for the most important factors.ResultsResponses were received from 28 experts working across 13 different countries and globally. The most common job titles reported were director and professor, with most based in national public health institutes (n = 9) and universities (n = 8). The Delphi survey found 37 distinct factors related to needs. Nine of the most important factors were included in the DCE. Among these, the most important factor was the ‘proportion of overall population not fully vaccinated’ (with a mean weight of 19.5), followed by ‘proportion of high-risk population not fully vaccinated’ (16.1), ‘health system capacity’ (14.2), ‘capacity to purchase vaccines’ (11.9) and the ‘proportion of the population clinically vulnerable’ (11.3).ConclusionsSeveral factors exist, extending beyond those currently used, which may lead to some countries having a greater need for vaccines compared to others. By assessing relative needs, this scoring tool can build on existing methods to further the role of equity in global COVID-19 vaccine allocation.

AB ÜYE DEVLETLERİNDE COVID-19 AŞILARININ ÖN SATIN ALMA SÖZLEŞMELERİ İÇİN VİYANA SATIM ANTLAŞMASININ (CISG’İN) UYGULANABİLİRLİĞİ

The European Commission has signed advanced purchase agreements with various vaccine manufacturers for the production, purchase and supply of the COVID-19 vaccine in the EU. Some parts of the agreement texts with AstraZeneca, CurevacAg and Pfizer Inc./BioNTech have been blacked out. In these agreements, it is understood that Belgian courts are competent and Belgian law is chosen. In a dispute, it is possible for the competent courts to apply CISG since Belgium is a party to the CISG. Even if choice of law hasn’t been made, the fact that the workplaces of all parties to these ageements are party to CISG, makes the CISG applicable. This study evaluates the applicability of the CISG to advanced purchase agreements (especially made with AstraZeneca) in EU Member States.

COVID-19 mRNA Vaccines Preserve Immunogenicity after Re-Freezing.

The massive COVID-19 vaccine purchases made by high-income countries have resulted in important sample losses, mainly due to the complexity of their handling. Here, we evaluated the possibility of preserving the immunogenicity of COVID-19 mRNA vaccines after re-freezing vials, following the extraction of the maximum possible number of samples, as an alternative approach to minimizing their wastage. Thus, we exposed the vaccine vials to different re-freezing conditions and evaluated mRNA integrity and the effects in mice after in vivo administration. We reveal that the mRNA integrity of Comirnaty® and Spikevax® vaccines remained unaffected after re-freezing during 1 month at −20 °C or −80 °C. The immunological responses also remained unchanged in mice after these re-freezing conditions and no apparent side effects were revealed. The preservation of mRNA integrity and immunogenicity under these handling conditions opens the possibility of re-freezing the mRNA COVID-19 vaccine vials to limit their wastage and to facilitate vaccination processes.

The potential cost-effectiveness of HPV vaccination among girls in Mongolia

IntroductionCervical cancer is a leading cause of cancer among women in Mongolia with an age-standardized incidence rate of 23.5 per 100,000. HPV vaccination has not been introduced nationally and Gavi co-financing support is not available in Mongolia. Extended Gavi pricing for HPV vaccine may be available from vaccine manufacturers for a number of years. To inform introduction decision-making, we evaluated the potential cost-effectiveness of HPV vaccination among girls and young women in Mongolia. MethodsWe used UNIVAC (version 1.4), a static decision model, to evaluate the health and economic outcomes of single-cohort vaccination among females from the government perspective compared to no vaccination. We modeled vaccine introduction over 10 birth cohorts starting in 2022 comparing quadrivalent or bivalent vaccine selection and vaccine pricing variations. We used locally-specific data for cancer incidence, mortality, treatment and costs. Model outcomes included cancer cases, hospitalizations, deaths, disability-adjusted life years (DALY), and costs presented in 2018 USD. Incremental costs and health outcomes were discounted at 3% and aggregated into an Incremental Cost-Effectiveness Ratio (ICER). ResultsThe base-case scenario of HPV vaccination among 9 year-old girls was projected to avert 5,692 cervical cancer cases, 3,240 deaths, and 11,886 DALYs and incur $2.4–3.1M more costs compared to no vaccination. At prices of ($4.50-$4.60/dose), we estimated an ICER of $166-$265/DALY averted among 9-year-olds. When price per dose was increased to reported mean vaccine purchase price for non-Gavi LMICs ($14.17/dose), the ICER ranged from $556–820/DALY averted. ConclusionHPV vaccination among girls is highly likely to be a cost-effective investment in Mongolia compared to no vaccination with projected ICERs less than 20% of the 2018 GDP per capita of $3,735.