Vaccine Purchase Research Articles

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.

A method for estimating the impact of new vaccine technologies on vaccination coverage rates.

Vaccines are one of the most cost-effective tools for improving human health and well-being. The impact of a vaccine on population health is partly determined by its coverage rate, the proportion of eligible individuals vaccinated. Coverage rate is a function of the vaccine presentation and the population in which that presentation is deployed. This population includes not only the individuals vaccinated, but also the logistics and healthcare systems responsible for vaccine delivery. Because vaccine coverage rates remain below targets in many settings, vaccine manufacturers and purchasers have a shared interest in better understanding the relationship between vaccine presentation, population characteristics, and coverage rate. While there have been some efforts to describe this relationship, existing research and tools are limited in their ability to quantify coverage rate changes across a broad set of antigens, vaccine presentations, and geographies. In this article, we present a method for estimating the impact of improved vaccine technologies on vaccination coverage rates. It is designed for use with low- and middle-income country vaccination programs. This method uses publicly available data and simple calculations based on probability theory to generate coverage rate values. We first present the conceptual framework and mathematical approach. Using a Microsoft Excel-based implementation, we then apply the method to a vaccine technology in early-stage development: micro-array patch for a measles-rubella vaccine (MR-MAP). Example outputs indicate that a complete switch from the current subcutaneous presentation to MR-MAP in the 73 countries ever eligible for Gavi support would increase overall vaccination coverage by 3.0–4.9 percentage points depending on the final characteristics of the MR-MAP. This change equates to an additional 2.6–4.2 million children vaccinated per year. Our method can be readily extended to other antigens and vaccine technologies to provide quick, low-cost estimates of coverage impact. As vaccine manufacturers and purchasers face increasingly complex decisions, such estimates could facilitate objective comparisons between options and help these decision makers obtain the most value for money.

Prospects of Vaccination Against COVID-19 and Road to DNA-based Vaccine: A Review

Covid-19 made the countries develop and adopt significant measures to control the spread of disease. For this purpose, firstly countries ordered the public to follow precautions, like, wearing a mask, sanitizer usage, and home quarantine. Then, countries endeavor for the preparation of vaccination started to not only stop the spread but to control and end the coronavirus. These efforts of vaccination started giving benefits in late 2020 and by the end of February 2021, many vaccines were approved conditionally and ready to use, while more were on the way to approval. Apparent from this, there is a great possibility that more clinically proven vaccines will be available on the market in the coming few years. Now, when there is the solution, "The Vaccine", the main point is how to meet the need for the vaccine on a global scale and capital generation for the purchase of vaccine. Till so far, mRNA vaccines are market-available, while DNA-type vaccines are under improvement, being experimented and tested. Because DNA vaccines usually only encode one protein from a pathogen; those may not be as effective if individuals need to mount an immune response to numerous proteins to gain protection, but this can be achieved by combining multiple vaccines. While mRNA vaccines guide the immune system to make a protein that will trigger an immune response without using a live virus and generate longer immunity.

АНАЛИЗ ОПЫТА ПО ПРОФИЛАКТИКЕ И ЛИКВИДАЦИИ БЕШЕНСТВА В СТРАНАХ ЕВРОПЫ

Rabies is an infectious disease of viral etiology with a fatal outcome for all types of non-immunized warm-blooded animals, including humans. The virus is mainly transmitted through bites or other contact with the saliva or blood of an infected animal, and symptoms appear when the virus reaches the brain. In the European Union (EU), where mass vaccination of cats and dogs has helped eliminate rabies in domestic animals, the disease is still circulating in a population of susceptible animals in the wild. Foxes and raccoon dogs are the main reservoir and source of the rabies pathogen in Europe, for this reason these two species of animals are targeted for vaccination campaigns. Europe's step-by-step approach to combating rabies in dogs and wild animals has proved that the disease can be controlled and eliminated from an animal source. 90% of EU funding for the eradication of rabies is spent on oral immunization (the purchase of vaccines and their distribution by aviation), while the remaining funds go to sampling and testing in order to monitor and control the effectiveness of vaccination. Uncontrolled border crossing by animals infected with the rabies virus from border disadvantaged countries makes it difficult to eradicate the disease on the territory of the EU. Within the framework of approved programs, the EU funded oral immunization against rabies among wild animals in buffer zones on the territories of non-EU countries. The risk of the spread of non-compliant vaccine baits is reduced due to regular testing of vaccine titers in all batches at the end of the storage period, but before their layout. To monitor the effectiveness and progress of oral vaccination in EU countries, samples are taken from foxes to check whether they have eaten the bait (and, consequently, the vaccine) and whether they are immune to the rabies virus. The goal is to take samples from 4 foxes from 100 km2, evenly distributed over the area of the vaccination zone.

Financing of Immunization Programs by Local Government Units in Poland as an Element of Health Policy.

Introduction: The scope and schedule of immunization in Poland is regulated by the Immunization Programme prepared and announced by the State Sanitary Inspector. There are two kinds of vaccines: compulsory vaccines, financed by the state budget at the disposal of the Minister of Health, and vaccines recommended by the central health authorities but financed by local governments within health policy programmes. Compulsory vaccines cover people up to 19 years of age and individuals at higher risk of infections. The public health programmes organized and financed by local governments play an important role in infectious disease control in the country. Objective: The objective of this study is to analyse health policy programmes including immunization programmes, which were developed, implemented and financed by local government units of all levels in Poland between 2016 and 2019. Material and Methods: This analysis covers data compiled by voivodes and submitted to the Minister of Health as annual information on public health tasks carried out by local government units. From the aggregate information, data on all health policy programmes conducted by individual local government units between 2016 and 2019, including immunization, were extracted and analysed. The data were obtained pursuant to the provisions of the act on access to public information. Results: In the analysed period, local government units implemented a total of 1737 health policy programmes that financed the purchase of vaccines, qualification tests for immunization and carrying out immunization by authorized medical entities. Among the vast majority of programmes, promotional activities were also implemented. Conclusions: In Poland, local governments are deeply engaged in the immunization of their citizens by organizing and financing specific health care programmes. These programmes are an essential addition to the state financial resources in infectious disease control. This engagement expresses local government maturity regarding the health needs of the population and public health measures. Communes are the most engaged units among all levels of local governments. It is probably due to close mutual communication between the people and local governments. The growing awareness of the important role of HPV immunization in the prevention of cervical cancer among local government units is reflected in the increase in the number of girls vaccinated against HPV and the increase in financial resources allocated for primary HPV prevention. The decrease in the number of people vaccinated against pneumococci may result from including pneumococcal vaccines in the compulsory immunization schedule.

COVID-19 Pandemic Tweets by Iranian Political Elites: A Content Analysis Study

COVID-19 Pandemic Tweets by Iranian Political Elites: A Content Analysis Study

Dynamics and Trends in Vaccine Procurement and Distribution in Zimbabwe

The subject of COVID-19 vaccines has generated debate across the globe as it has created a fecund ground for a plethora of dynamics such as vaccine diplomacy, misinformation, and struggle for dominance among global powers to mention but a few. Thus, the vaccine subject has taken-center stage in global discourses, resulting in developing and developed nations experiencing challenges in respect to purchase, transparency, and accountability in the administration of vaccines. The subject of vaccines in Zimbabwe has provoked public skepticism indicative of the existing trust deficit between government and the citizens. This emanates from strong evidence of abuse of public resources and hence questions of transparency and accountability especially in relation to disaster situations. To this end, this paper seeks to bring to light the trends and dynamics in vaccine procurement and distribution in Zimbabwe. The study examines the correlation between vaccine diplomacy (donation-trap diplomacy) and vaccine purchases. A chronological analysis of the approved vaccines, rejection of Johnson and Johnson and sudden acceptance, natural resource implications of the donations from ALROSA, poor public resource management, vaccine shortages, vaccine misinformation and vaccine cheating. Possible ways of enhancing vaccine intake through quality information are also discussed and Zimbabwe`s performance against other African nations is examined. The research ends by proposing a series of questions which should be embraced to fully comprehend the trends and dynamics of vaccine procurement and distribution.

COVID‐19 Vaccine Inequity: High time to calibrate the global moral compass

COVID‐19 Vaccine Inequity: High time to calibrate the global moral compass

Pengadaan Vaksin Covid-19 Triwulan I Tahun 2021 di Indonesia Persfektif Hukum Ekonomi Syariah

In the first quarter of 2021, Indonesia will purchase vaccines by importing COVID-19 vaccines from COVID-19 vaccine companies. Islamic Economic Law regulates the process of purchasing vaccines by importing Covid-19 vaccines, how transactions are completed, and aspects of the safety and halalness of Covid-19 vaccines. The purpose of this study was to determine the import contract of Indonesia's Covid-19 vaccine with halal guarantees and health aspects in accordance with sharia economic law. This research uses literature study method. The data analysis method used in this research is deductive analysis. The data collection method in this research is documentation. Sources of data used are primary and secondary data sources. The main data sources used in this study are COVID-19 vaccines, vaccine books, import and export of Islamic law and economics, Islamic law, trade law, and documents related to precedents contained in Islamic law. Sources of supporting data used in this research come from scientific studies, articles, and books that support the research topic. From the perspective of Islamic economic law, the purchase of the Covid-19 vaccine in Indonesia is included in the Salam sale and purchase contract. MUI has announced that the Covid-19 vaccine product is halal and multifaceted. In accordance with Presidential Regulation No. 99 regarding vaccine procurement and vaccination implementation in 2020, the current sales contract is in effect. For the Covid-19 pandemic, if there is a mandatory threat, the contract can be extended. Or cancel. The government guarantees the safety, type and quality of halal products as well as the effectiveness of the Covid-19 vaccine (namely the POM and MUI). The type of covid-19 vaccine with guaranteed halal products and an emergency use license is the type of vaccine from PT. Bio Farma (Persero), Sinovach Biontech Ltd, AstraZeneca.Keywords : vaccine procurement, covid-19 vaccine, salam contract

A Game Theoretic Analysis of Competition Between Vaccine and Drug Companies during Disease Contraction and Recovery.

BackgroundInfectious diseases such as COVID-19 and HIV/AIDS are behaviorally challenging for persons, vaccine and drug companies, and donors.MethodsIn 3 linked games in which a disease may or may not be contracted, persons choose risky or safe behavior (game 1). Two vaccine companies (game 2) and 2 drug companies (game 3) choose whether to develop vaccines and drugs. Each person chooses whether to buy 1 vaccine (if no disease contraction) or 1 drug (if disease contraction). A donor subsidizes vaccine and drug developments and purchases. Nature probabilistically chooses disease contraction, recovery versus death with and without each drug, and whether vaccines and drugs are developed successfully. COVID-19 data are used for parameter estimation.ResultsEach person chooses risky behavior if its utility outweighs safe behavior, accounting for nature’s probability of disease contraction which depends on how many are vaccinated. Each person buys a vaccine or drug if the companies produce them and if their utilities (accounting for side effects and virus mutation) outweigh the costs, which may be subsidized by a sponsor.DiscussionDrug purchases depend on nature’s recovery probability exceeding the probability in the absence of a drug. Each company develops and produces a vaccine or drug if nature’s probability of successful development is high, if sufficiently many persons buy the vaccine or drug at a sales price that sufficiently exceeds the production price, and if the donor sponsors.ConclusionAccounting for all players’ interlinked decisions allowing 14 outcomes, which is challenging without a game theoretic analysis, the donor maximizes all persons’ expected utilities at the societal level to adjust how persons’ purchases and the companies’ development and production are subsidized.HighlightsA game theoretic approach can help explain the production decisions of vaccine and drug companies, and the decisions of persons and a donor, impacted by Nature.In 3 linked games, N persons choose risky behavior if its utility outweighs safe behavior.Vaccine and drug companies develop vaccines and drugs sponsored by a donor if profitable, allowing 14 outcomes.

Particularités de la 3e vague de la pandémie à COVID-19 en Afrique sub-Saharienne, cas de la République Démocratique du Congo comme exemple

Particularités de la 3e vague de la pandémie à COVID-19 en Afrique sub-Saharienne, cas de la République Démocratique du Congo comme exemple

Government's Policy on Controlling the Covid-19 Virus Based on the Game Theory Approach: Closing Jobs or Purchasing Vaccines

Background: The tools to control COVID-19 virus and this epidemic have been tested in all countries and at different levels. At the community level, they include observing hygienic principles, such as observing social distance, wearing masks, washing hands, observing cleanliness, observing personal belongings, and etc. Also at the macro level, governments have taken measures to combat the virus, such as closing cities, purchasing vaccines hygiene training. Given the high costs of closing cities and purchasing vaccines for governments, they may be willing to select and use a combination of them to control the virus. Considering these 2 factors as 2 competitors in the effectiveness of COVID-19 control, this study sought to find an equilibrium point to control the virus. Methods: An infinite 2-player game was defined by considering the number of cities closed per person-day and the number of vaccine purchased per person, both of which have continuous and infinite space. On the other hand, a significant basic criterion for governments can be the cost and number of patients with the disease. Hence, the game was defined based on 2 criteria. A case study was also solved for the sake of clarity. Results: The government must close offices for at least 12 days and inject 2 doses of the vaccine to about 28 million people in order to achieve its goal of reducing costs and reducing the incidence of the disease. Conclusion: By solving the proposed model, it was found that for the initial control of the disease, the purchase and injection of vaccines can be more effective, but in order to further reduce and control the disease, it is better to close jobs. Analyses also showed that governments that are less willing to spend money on disease control could close jobs.

Best Efforts in the Taxonomy of Obligation – The Case of the EU Vaccine Contracts

AbstractThe purchase of Covid-19 vaccines by the EU Commission as agent for the Member States has caused substantial political discussion, including a lawsuit against the producer AstraZeneca in Brussels in 2021. The article looks at these purchase contracts as examples for a problematic use of “best efforts“ clauses in commercial contracting, considering some key jurisdictions. The clauses are discussed from a drafting perspective, including their function and their theoretical background in comparative law. It concludes with a primer for the drafting process, looking at some basic contracting schemes for softening or intensifying obligations.

COVID-19 Vaccination in Lower-Middle Income Countries: National Stakeholder Views on Challenges, Barriers, and Potential Solutions.

The development of COVID-19 vaccines does not imply the end of the global pandemic as now countries have to purchase enough COVID-19 vaccine doses and work towards their successful rollout. Vaccination across the world has progressed slowly in all, but a few high-income countries (HICs) as governments learn how to vaccinate their entire populations amidst a pandemic. Most low- and middle-income countries (LMICs) have been relying on the COVID-19 Vaccines Global Access (COVAX) Facility to obtain vaccines. COVAX aims to provide these countries with enough doses to vaccinate 20% of their populations. LMICs will likely encounter additional barriers and challenges rolling out vaccines compared HICs despite their significant experience from the Expanded Programme on Immunisation (EPI). This study explores potential barriers that will arise during the COVID-19 vaccine rollout in lower-middle-income countries and how to overcome them. We conducted sixteen semi-structured interviews with national-level stakeholders from Ghana and Bangladesh (eight in each country). Stakeholders included policymakers and immunisation programme experts. Data were analysed using a Framework Analysis technique. Stakeholders believed their country could use existing EPI structures for the COVID-19 vaccine rollout despite existing challenges with the EPI and despite its focus on childhood immunisation rather than vaccinating the entire population over a short period of time. Stakeholders suggested increasing confidence in the vaccine through community influencers and by utilising local government accredited institutions such as the Drug Authorities for vaccine approval. Additional strategies they discussed included training more health providers and recruiting volunteers to increase vaccination speed, expanding government budgets for COVID-19 vaccine purchase and delivery, and exploring other financing opportunities to address in-country vaccine shortages. Stakeholders also believed that LMICs may encounter challenges complying with priority lists. Our findings suggest that COVID-19 vaccination is different from previous vaccination programs, and therefore, policymakers have to expand the EPI structure and also take a systematic and collaborative approach to plan and effectively rollout the vaccines.

Post-vaccination Monitoring to Assess Foot-and-Mouth Disease Immunity at Population Level in Korea.

In South Korea, domestic cattle, pigs, and goats were subjected to mandatory foot-and-mouth disease (FMD) vaccination and year-round serosurveillance since 2011. In 2020, approximately USD 95 million was spent solely for FMD vaccine purchase for 59 million livestock, and 1.25 million samples were tested to estimate the population immunity and demonstrate the absence of virus circulation. As the FMD vaccination program was revised in 2018, the post-vaccination monitoring (PVM) was designed to evaluate the effectiveness of the vaccine program of three vaccines approved for routine use. To this end, monitoring post-vaccination immunity has been conducted by collecting 35,626 serum samples at 28 days post-vaccination following regular national vaccinations, which were carried out in April and in October in 2020. The design of the serological test for PVM was specially targeted at particular livestock groups, including dairy cattle, goats, and beef cattle aged 6–12 months, which were generally estimated to have a low expected seroprevalence. The risk factors had also been identified, considering the increased likelihood of infection in a particular location, herd size, and husbandry system applied in a targeted sample collection. Serum sample collection and SP-O and NSP antibody tests were performed by local veterinary laboratories using commercially available ELISAs. The current FMD vaccination program, which was performed twice a year following the regimen of primary vaccination and boost, resulted in over 80% population immunity. The seroprevalence monitored after the vaccination in fall was higher than the one studied in spring except in pigs. It was demonstrated that the seroprevalence of risk-based targeted samples ranged from 93.8 to 100% in cattle, 63.2 to 100% in pigs, and 20.0 to 100% in goats. Of note is the area near the North Korean borders which showed a relatively low seroprevalence among the targeted regions, and no NSP sero-positive reactor was detected in this region. When subpopulation immunity at the individual level was assessed, the seroprevalence in young cattle stock was slightly lower (95.8%) than that of adults (98.4%). In conclusion, the FMD vaccination campaign has been successfully implemented in Korea, and the PVM can be a supplementary program for massive routine surveillance in terms of providing timely information needed both to estimate population immunity and to properly target “risk-based surveillance.”

Economic evaluation of rotavirus vaccination: an important step of the introduction to the national immunization program in Thailand

ABSTRACT Introduction World Health Organization recommends rotavirus vaccine for all national immunization programs (NIPs). To provide country-specific evidence, we conducted economic evaluation of a monovalent rotavirus vaccination using specific data of the pilot phase in Thailand. Method A Markov model was adopted to compare the 2020 birth cohort once receiving rotavirus vaccination versus no vaccination from healthcare and societal perspective over five years. Data on disease burden, vaccine effectiveness, costs, and utilities were taken from a cohort study in two provinces of Thailand. Sensitivity analyses were performed to test the robustness of the results. Results Rotavirus vaccination would reduce rotavirus diarrhea and costs of illness by 48% and 71%, respectively, over the first five years of life. At USD 13 per dose, vaccine was cost-effective with the ICERs of USD 4,114 and USD 1,571per QALY gained from healthcare and societal perspective, respectively. Results were sensitive to incidence and vaccine cost. The budget for vaccine purchasing was estimated at USD13 million per year. Conclusion Incorporating rotavirus vaccination into the NIP substantially reduced health and cost outcomes and was cost-effective for both perspectives. However, the government needs to negotiate vaccine price prior to program implementation to achieve favorable budget impact.

Challenges to COVID-19 vaccine supply chain: Implications for sustainable development goals

The COVID-19 outbreak has demonstrated the diverse challenges that supply chains face to significant disruptions. Vaccine supply chains are no exception. Therefore, it is elemental that challenges to the COVID-19 vaccine supply chain (VSC) are identified and prioritized to pave the way out of this pandemic. This study combines the decision-making trial and evaluation laboratory (DEMATEL) method with intuitionistic fuzzy sets (IFS) to explore the key challenges of the COVID-19 VSC. The IFS theory tackles the uncertainty of key challenges while DEMATEL addresses the interlaced causal relationships among crucial challenges to the COVID-19 VSC. This work identifies 15 challenges and reveals that ‘Limited number of vaccine manufacturing companies’, ‘Inappropriate coordination with local organizations’, ‘Lack of vaccine monitoring bodies’, ‘Difficulties in monitoring and controlling vaccine temperature’, and ‘Vaccination cost and lack of financial support for vaccine purchase’ are the most critical challenges. The causal interactions along with mutual relationships among these challenges are also scrutinized, and implications for sustainable development goals (SDGs) are drawn. The results offer practical guidelines for stakeholders and government policy makers around the world to develop an improved VSC for the COVID-19 virus.

A pandemic treaty for a fragmented global polity

A pandemic treaty for a fragmented global polity

Investigating the procurement system for understanding seasonal influenza vaccine brand availability in Europe.

Timely knowledge of which influenza vaccine brands are procured and where is of interest to inform site-selection for brand-specific influenza vaccine effectiveness (VE) studies. Vaccine procurement is a key determinant of brand availability. We therefore sought to understand how the procurement for seasonal influenza vaccine in Europe is organized, how this drives brand availability and how procurement data could enable to determine brand availability pre-season. Structured telephone interviews were conducted with 15 experts in 16 European countries between 2017 and 2019 to collect information on the influenza vaccine procurement systems. Sources of (brand-specific) procurement data were identified and assessed on public accessibility. Vaccine type and brand availability and timelines were determined for the 2019-20 season to understand how procurement systems drive brand availability and diversity. Four main types of procurement systems for seasonal influenza vaccination campaigns were identified: national public tenders (Croatia, Denmark, Finland, Ireland, Lithuania, Netherlands, Norway, Scotland, Slovenia), regional public tenders (Italy, Spain, Sweden), direct purchase of vaccines by GPs (England, Wales) or pharmacies (Belgium, France, Germany, Greece) from manufacturers or wholesalers. National public tender outcomes are publicly available and timely; brand availability at clinic level can generally be deduced or narrowed down to two brands. Regional tender outcomes are more difficult to find, known very late or not available. In Italian and Spanish regions tenders may be awarded only a few weeks before the seasonal campaign. No public procurement information is available for countries with direct purchase. At the country-level, brand diversity is generally lower for countries with national public tenders than for countries with regional public tenders or direct purchase. In only a few countries, procurement data at the brand level is both publicly available and timely. Therefore the usefulness of procurement data for prospective site-selection for brand-specific VE studies is limited.