Vaccine: X

BackgroundOn June 24, 2025, the North Carolina Department of Health and Human Services (NCDHHS) announced a measles case from an international traveler which resulted in multiple exposures including attendance at the Greensboro Science Center, which hosts over 621,000 visitors annually. Given declining measles vaccination rates across the US and ongoing national outbreaks, we estimated potential secondary cases that might occur if measles were introduced into different elementary schools in North Carolina. MethodsWe used kindergarten immunization data from NCDHHS (2019-2023) to estimate potential secondary cases using a Susceptible, Exposed, Infected, Recovered, Vaccinated (SEIRV) model. We then estimated the marginal impact of vaccination on outbreak risk. ResultsOnly 47 of North Carolinas 100 counties have the recommended full vaccination rates of at least 95%. We found that over 41,000 out of over 641,000 (6.5%) elementary-aged students have not been fully vaccinated against the measles. Of the 1,474 elementary schools we considered, 142 elementary schools have a greater than 50% probability of at least 10 cases should measles be introduced; 28 schools have probabilities exceeding 80%. LimitationsWe assume that the SEIRV framework adequately captures the dynamics of students within a school with homogeneous mixing. ConclusionsMeasles vaccination coverage in North Carolina has decreased, leaving many children at risk for infection. Many schools have vaccination levels low enough to cause large, sustained outbreaks if a single measles case were introduced. By providing these approximate, order-of-magnitude estimates to public health officials, they can adequately plan for outbreak response and prioritize school and communities at risk for vaccination campaigns.

New maternal vaccines have the potential to reduce morbidity and mortality for infants from common illnesses that pose the greatest risk in the earliest phase of their life. Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory infections among infants under six months of age. With the recent approval of a maternal vaccine for RSV, this study aimed to understand decision-making factors among pregnant and lactating women for receiving a newly licensed vaccine during pregnancy. Pregnant and lactating women from two counties in Kenya, Nakuru and Mombasa, were recruited to complete a cross-sectional survey in August-September 2022. The survey explored topics of trust in various types of sources for information about new maternal vaccines, the importance of a healthcare providers recommendation of a new maternal vaccine, and concerns about new maternal vaccines. We surveyed 400 pregnant and lactating women. In both counties, information about the new vaccine was most trusted when coming from healthcare providers, and least trusted when coming from social media. Womens intention to receive a new maternal vaccine was heavily influenced by a positive recommendation from a healthcare provider. The greatest concerns about a new vaccine were side effects and the vaccines ingredients. The information and recommendation from a healthcare provider are important influences on decision-making for new maternal vaccines. As a new maternal immunization for RSV becomes more available, healthcare providers should be engaged early to reduce vaccine hesitancy amongst providers and equip providers with appropriate information tailored to pregnant women about the RSV maternal vaccine.

Cervical cancer is one of the most prevalent cancer diseases in women caused by persistent infection with one of 13 sexually transmitted high-risk human papillomavirus (HPV) types. Vaccination can significantly reduce the prevalence of this burden in low-middle income countries. However, HPV vaccination is not included in the Tunisian immunization program. Since the economic evaluation of HPV vaccines is crucial to inform public-health decisions, the World Health Organization (WHO) recommends that a cost-effectiveness analysis of HPV vaccination is conducted before nationwide introduction. This study aimed to conduct a cost-effectiveness analysis of incorporating different HPV vaccines into the national immunisation schedule in Tunisia. The potential health and economic impacts of human papillomavirus (HPV) vaccination were evaluated through comparative modelling analysis using two published static models (UNIVAC and Papillomavirus Rapid Interface for Modelling and Economics (PRIME)). Academic literature and anecdotal evidence were included on the demographic variables, cervical cancer incidence and mortality, treatment costs, vaccine delivery costs and other model parameters. The cost of vaccination, treatment costs saved, net costs, cases and deaths averted, life years saved, disability-adjusted life years (DALYs) prevented, and incremental cost-effectiveness ratios were predicted and reported as primary outcomes. The incremental cost-effectiveness ratios (ICERs) were estimated per disability-adjusted life years (DALYs) averted using the cost-effectiveness threshold (CET) defined by the World Health Organisation (WHO). All HPV vaccines were very cost effective (with every disability-adjusted life-year averted costing less than the cost-effectiveness threshold). The analyses were done from a health system and societal perspective. Despite model differences, the PRIME and UNIVAC models yielded similar vaccine-impact estimates.

BackgroundBy March 2021, California had one of the least equitable COVID-19 vaccine distribution programs in the US. To rectify this, Governor Newsom ordered 4 million vaccine doses be reserved for the census tracts in the lowest quartile of the Healthy Places Index (HPI). California plans to lift state-wide restrictions on June 15th, 2021, as long as test positivity and vaccine equity thresholds are met in the states most vulnerable neighborhoods. This short investigation examines current vaccine equity and forecasts where California can expect to be when the economy fully reopens. MethodsCurrent vaccine equity was investigated with simple linear regression between the county mean HPI and both single and full-dose vaccination rate. Future vaccination coverage per county were predicted using a compartmental mathematical model based on the average rate over the previous 30 days with four different rate-change scenarios. ResultsCounty mean HPI had a strong positive association with both single and full dose vaccination rates (R2: 0.716 and 0.737, respectively). We predict the overall state rate will exceed 50% fully vaccinated by June 15th if the current rates are maintained; however, the bulk of this coverage comes from the top 18 counties while the remaining 40 counties lag behind. DiscussionThe clear association between county HPI and current vaccination rates shows that California is not initiating opening plans from an equitable foundation, despite previous equity programs. If nothing changes, many of the most vulnerable counties will not be prepared to open without consequences come June 15th.

BackgroundProvincial decisions to fund a new immunization program are generally made on a case-by-case basis, without systematic consideration of how the new immunization program may fit within the larger provincial immunization portfolio. AimThe goal of this study was to develop evidence and tools to guide policy-makers in making fiscally and ethically responsible decisions on which adult immunization programs to include in their portfolio under various constrained budgetary scenarios. MethodsUsing previously published infectious disease models, cost-utility data was estimated for adult pneumococcal, influenza, pertussis, and shingles immunization programs. This data was then inputted into a newly developed constrained optimization model to determine portfolios of immunization programs that maximize either population health or incremental net monetary benefit, subject to a budget constraint. Sensitivity analyses were conducted on model parameters such as vaccine costs, cost-effectiveness thresholds, and the budget constraint. ResultsOptimized solutions changed dramatically based on the number of immunization programs included, total budget, what was optimized for (i.e., population health or incremental net monetary benefit), the cost-effectiveness threshold and the assumed vaccine prices. Maximal health gains and budget spending was achieved when optimizing based on population health. Reductions in health gains and budget spending were observed at a CAN$50,000 cost-effectiveness threshold, and at a CAN$30,000 threshold, the budget was significantly underutilized and health gains were noticeably reduced. ConclusionIf budgets for the adult immunization portfolio are fixed, then shifting to more expensive programs that offer large health benefits may be preferable. However, if budgets can be spread across various public health programs (i.e., childhood immunization, well-baby programs), it may make more sense to optimize based on cost-effectiveness. Constrained optimization tools could improve goals-based decision-making and allow for transparent and effective methods to make allocation decisions. HighlightsO_LIOptimized solutions changed dramatically based on the number of immunization programs available, total budget, and the cost-effectiveness threshold. C_LIO_LIIf budgets for the adult immunization portfolio are fixed, then shifting to more expensive programs that offer large health benefits may be preferable. C_LIO_LIIf budgets can be spread across various public health programs, it may make more sense to optimize based on cost-effectiveness. C_LIO_LIConstrained optimization tools could improve goals-based decision-making and allow for transparent and effective methods to make allocation decisions. C_LI

Declines in routine influenza vaccination rates have become a cause for concern as influenza vaccine coverage rates have declined among Black, Non-Hispanic children compared to an increase in coverage among White, Non-Hispanic children ages 6 months to 17 years old. Influenza season years analyzed were 2012-2022 using data provided by the US Center for Disease Controls FluVaxView database. Data for this database is sourced from the National Immunization Survey-Flu (NIS-Flu) and the Behavioral Risk Factor Surveillance System (BRFSS) survey. White, Non-Hispanic children saw an increase in vaccination coverage from 55.8% to 60.3%, whereas Black, Non-Hispanic children decreased from 58.2% to 52.9% coverage. Chi-squared tests with Yates correlation were performed to find statistical significance. Vaccination coverage rate changes for both demographics were found to be statistically significant at p < 0.00001. 70% influenza vaccination coverage rate remains the US Department of Healths HealthyPeople 2030 initiatives goal for all demographics and may be achieved by utilizing interventional tools such as motivational interviewing, provider-patient dialogue, community-based vaccination clinics, or home visits. Evidence-based interventional provider-patient dialogue has had success in increasing vaccination rates among other vaccines. Continued research into the cause of influenza vaccination rate decline among vulnerable and medically underserved populations is needed to best implement vaccine-based interventions.

A SARS-CoV-2 DNA vaccine targeting the spike protein and delivered by jet injection, nCOV-S(JET), previously shown to protect wild-type and immunosuppressed Syrian hamsters (Mesocricetus auratus), was evaluated via two needle-free delivery methods in rhesus macaques (Macaca mulatta). The methods included intramuscular delivery of 2 mg per vaccination with the PharmaJet Stratis device and intradermal delivery of 0.4 mg per vaccination with the PharmaJet Tropis device. We hypothesized that the nCOV-S(JET) vaccine would mount detectable neutralizing antibody responses when delivered by needle-free jet injection by either the intradermal or intramuscular route. When delivered intramuscularly, the vaccines elicited neutralizing and variant (Beta, Gamma, and Delta) cross-neutralizing antibodies against SARS-CoV-2 in all six animals after three vaccinations. When delivered at a lower dose by the intradermal route, strong neutralizing antibody responses were only detected in two of six animals. This study confirms that a vaccine previously shown to protect in a hamster model can elicit neutralizing and cross-neutralizing antibodies against SARS-CoV-2 in nonhuman primates. We posit that nCOV-S(JET) has the potential for use as booster vaccine in heterologous vaccination strategies against COVID-19.

Despite extensive scientific research supporting the safety and effectiveness of approved vaccines, debates about their use continue in the public sphere. A paper prominently circulated on social media concluded that countries requiring more infant vaccinations have higher infant mortality rates (IMR), which has serious public health implications. However, inappropriate data exclusion and other statistical flaws in that paper merit a closer examination of this correlation. We re-analyzed the original data used in Miller and Goldmans study to investigate the relationship between vaccine doses and IMR. We show that the sub-sample of 30 countries used in the original paper was an unlikely random sample from the entire dataset, as the correlation coefficient of 0.49 reported in that study would only arise about 1 in 100,000 times from random sampling. If we investigate only countries with high or very high development, human development index explains the variability in IMR, and vaccine dose number does not. Next, we show IMR as a function of countries actual vaccination rates, rather than vaccination schedule, and show a strong negative correlation between vaccination rates and IMR. Finally, we analyze United States IMR data as a function of Hepatitis B vaccination rate to show an example of increased vaccination rates corresponding with reduced infant death over time. From our analyses, it is clear that vaccination does not predict higher IMR as previously reported.

Backgrounds and PurposeAntigenic match between selected vaccine virus and circulating virus crucial to achieve high vaccine effectiveness for seasonal flu. Due to the time-consuming process of producing eggs, vaccine candidate viruses are currently selected 5-6 months ahead of the flu season. New non-egg-based vaccine production technologies have emerged with the potential to improve production efficiency and to revise current vaccine formulation schedules. In this study, we aim to 1) identify the past flu seasons where the opportunity to improve vaccine decision existed if rapid vaccine production were available and to 2) quantify the impact of revising the current vaccine decision schedule, where new vaccine production technologies allow more time for specimen collection prior to vaccine virus selection. MethodsWe extracted the trend in the viral activity of season-predominant strain in three data points: when vaccine decision was made, in between vaccine decision and season starts, and after season starts. Between 2012 and 2020, we first identified the past flu seasons where the season-dominant strains presented increasing activity only after vaccine decisions had already been made in February for the Northern Hemisphere. Using an epidemiological model (SEIR) of season flu in the US, we evaluated the impact of updating vaccine decisions on the epidemic size and the number of flu hospitalizations in the United States. ResultsIn the past flu seasons between 2012 and 2020, the timing when the clades or subclades that predominantly circulated during flu season emerged varied by season. In particular, in 2013/14, season-dominant H3N2 subclade emerged after vaccine decisions were made, contributing to the mismatch between vaccine and circulating virus. If the H3N2 component of the vaccine were updated given the additional viral activity data collected after February, our simulation model showed that the updated vaccine could have averted 5,000-65,000 flu hospitalizations, depending on how much vaccine effectiveness could improve with matching vaccine virus. On the other hand, updating the B/Victoria vaccine component did not yield substantial change in flu burden in the 2019/20 season. ConclusionsWith rapid vaccine production, revising the timeline for vaccine selection can result in substantial epidemiological benefits, particularly at times when additional data help improve the vaccine effectiveness through better match between vaccine and circulating viruses.

Influenza seasons occur annually, building immune history for individuals, but the influence of this history on subsequent influenza vaccine protection remains unclear. We extracted data from an animal trial to study its potential impact. The trial involved 80 ferrets, each receiving either one type of infection or a placebo before vaccination. We quantified the vaccine protection by evaluating hemagglutination inhibition (HAI) antibody titer responses. We tested whether hosts with different infection histories exhibited similar level of responses when receiving the same vaccine for all homologous and heterologous outcomes. We observed that different pre-existing immunities were generally beneficial to vaccine induced responses, but varied in magnitude. Without pre-immunity, post-vaccination HAI titers after the 1st dose of the vaccine were less likely to be above 1:40, and a booster shot was needed. Our study suggests that pre-existing immunity may strengthen and extend the homologous and heterologous vaccine protection.

BackgroundOlder adults face a disproportionately high risk of severe influenza, yet the standard inactivated vaccine (IIV) offers suboptimal protection in this population. This study evaluates the cost-effectiveness of replacing IIV with the recombinant influenza vaccine (RIV) for adults aged [&ge;]50, [&ge;]65, and [&ge;]80 years in Hong Kong. MethodsA decision tree model was used to compare RIV with IIV for adults aged [&ge;]50, [&ge;]65, and [&ge;]80 years in Hong Kong, from a societal perspective. Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were evaluated with the impact of parameter uncertainty on the results assessed via deterministic and probabilistic sensitivity analyses. ResultsFor adults [&ge;]50 years, RIV increased total costs by USD5.1 (HKD39.8) per person and gained 0.00012 QALYs (ICER: USD40,659 [HKD317,140] per QALY) compared to IIV. Among adults [&ge;]65 years, RIV cost USD6.0 (HKD46.8) more and gained 0.00021 QALYs (ICER: USD29,077 [HKD226,801] per QALY). For adults [&ge;]80 years, RIV cost USD3.2 (HKD25.0) more and gained 0.00015 QALYs (ICER: USD21,092 [HKD164,518] per QALY). ICERs were less than willingness-to-pay thresholds of one to three times Hong Kongs gross domestic product per capita. ConclusionsRIV is cost-effective compared with IIV for adults [&ge;]50, [&ge;]65, and [&ge;]80 years in Hong Kong, with the lowest ICER observed in individuals [&ge;]80 years.

AO_SCPLOWBSTRACTC_SCPLOWDespite the well-documented life-saving potential of pneumococcal conjugate vaccines (PCV) and global efforts to widen vaccine availability, access to PCV in middle-income countries (MICs) has remained suboptimal due, in part, to vaccine pricing and limited external funding opportunities. To understand gaps and opportunities for improving vaccine equality, this qualitative study engaged government policymakers and program leaders from MICs that do not currently have PCV in their national immunization programs to explore their perspectives on decision-making contexts and constraints related to PCV introduction. In-depth interviews with 17 participants from Egypt, Jordan, Sri Lanka, and Thailand in 2023 documented that, despite high routine immunization coverage and commitment toward building equitable health systems, implementing new vaccines such as PCV has remained challenging. Among the six thematic areas that emerged, two were strong enablers to vaccine implementation: 1) the existence of strong primary healthcare systems; and 2) established policy processes for vaccine decision-making. Three themes that emerged have historically hindered PCV introduction, including; 1) limited information on disease burden and available vaccine products; 2) competing country health priorities; and 3) financing challenges. The interplay of these thematic areas has documented a paradox unique to MICs, further contributing to inequalities in vaccine access. While a subset of MICs recently became eligible for support from Gavi, the Vaccine Alliance for introducing new vaccines, the marketplace has historically lacked tiered vaccine pricing that MICs could sustain for the long term. This is despite the great need with existing inequities and a substantial proportion of the worlds low-income and displaced populations. Finally, participants pointed to opportunities to address barriers through support from global and regional actors providing technical capacity-strengthening, advocacy, and strategic financial support. These findings are informative for strengthening equality in access to vaccines and developing sustainable strategies to introduce and sustain life-saving childhood vaccines, including PCV.

IntroductionOutbreaks of measles have been frequently reported despite the availability of an effective vaccine. In this systematic review we examine the potential factors that could impact the effectiveness of the measles vaccine (MV) in children. MethodsWe conducted a literature search using PubMed and Google Scholar for primary articles published between January 2014 and July 2024. Articles reporting the effectiveness or immunogenicity of MV in children aged 0-15 years were included. Additionally, we use regression analysis on data available from few cohort studies in India and epidemiological modelling simulations to assess the effect of factors on vaccine effectiveness (VE). ResultsOverall, 34 primary articles involving 151888 children who had received the MV were included in the analysis. Key factors that may affect VE were malnutrition, genetic variants, chemotherapy and gender. Through statistical modelling we identified an inverse relationship between malnutrition and measles VE and estimated the possible percentage decrease in VE due to malnutrition across different states of India. Additionally, simulations from a Susceptible-Infected type model showed the effect of varying VE on the modelling outcomes and measles elimination targets. ConclusionsWe identified a few key factors including malnutrition, genetic variants, chemotherapy and gender that impact measles VE. Therefore, in addition to maintaining WHO recommended vaccine coverages, addressing the problems related to VE is crucial for achieving measles elimination targets.

Typhoid remains a preventable disease that primarily affects low- and middle-income countries. We conducted a scoping review to synthesize evidence on the epidemiological models and economic analyses of typhoid conjugate vaccine (TCV), focusing on the cost of illness of typhoid, the cost of vaccination, cost-effectiveness, and public health benefits of TCV. A search was conducted across PubMed, Web of Science, International Health Technology Assessment, Scopus, and the National Health Service Economic Evaluation Database, following Arksey and OMalleyss framework. Screening and data extraction were managed using Covidence and an Excel-based template. Extracted data included study design, population, outcomes, model parameters, and cost-effectiveness data, converted to 2024, United States Dollars (USD) for comparability. Findings were summarized by key outcomes. The economic burden of typhoid varied by region, care type, and demographics. Direct medical costs ranged from USD 1.3 to USD 1543, direct non-medical costs varied from USD 1.3 to USD 60.1, and indirect costs ranged from USD 14.1 to USD 794. Cost of vaccination per dose ranged from USD 2.80 - USD 5.40 (India), USD 0.87 - USD 1.01 (Malawi), and USD 2.99 (Zimbabwe), while the cost of delivering the vaccine ranged from USD 0.48- USD 0.99 (financial) and USD 1.11 - USD 1.87 (economic) per dose. Models predicted 2-94% case reductions and 0-100% mortality reductions. Economic evaluations reported ICERs of USD 124 to USD 53,773 per DALY averted and USD - 4,251 to USD 103,344 per QALY gained, with high-incidence settings often resulting in cost savings. Sensitive parameters were typhoid incidence rate, vaccine efficacy, and vaccination costs. TCV introduction is influenced by disease burden, vaccination costs, and health outcomes, which vary by region. Cost-effectiveness depends on incidence, perspective, and vaccine strategy, emphasizing the need for context-specific evaluations. Targeted strategies, particularly in high-incidence and urban areas, are often cost-effective and sometimes cost-saving.

BackgroundEstimating attributable risk (AR) through self-controlled case series (SCCS) analyses alone may limit generalizability because SCCS only incorporate vaccinated patients with the outcome (e.g., Guillain-Barre syndrome [GBS]) who may differ from the overall population recommended for vaccination. ObjectiveWe aimed to demonstrate background event incidence rates impact on vaccine-specific GBS ARs and to standardize ARs across different vaccine studies by applying a generalizable, population-based GBS background rate for improved comparability and to better estimate the expected population-level ARs. MethodsWe identified post-licensure SCCS vaccine studies and GBS background rates using US Medicare data via targeted literature review. GBS control period rates from SCCS vaccine studies were extracted or calculated. Population-level ARs were calculated for each vaccine using published background GBS rates and the original SCCS-generated incidence rate ratios (IRRs). ResultsPublished vaccine-specific GBS IRRs ranged from 2.02 (95%CI: 0.93-4.40) for RSVPreF to 4.96 (95%CI: 1.43-17.27) for recombinant zoster vaccine (RZV). Study-specific ARs per 100,000 doses ranged from 0.28 (H1N1) to 0.90 (RSVPreF). Vaccines with lower control period GBS rates had a lower attributable risk for a given IRR. After standardization using published background GBS rates, population-level ARs were higher for vaccines with higher IRRs. For example, when using the H1N1 vaccine control period rate as the GBS background rate for AR calculation, RSVPreF had the lowest AR per 100,000 doses (0.21) and RZV the highest (2.37). ConclusionAR calculation is dependent on the control period rate within a given SCCS analysis. ARs derived exclusively from SCCS analyses may lead to incorrect conclusions regarding an adverse events absolute risk if included in product labels due to a lack of external validity. Using a representative background rate from the recommended vaccinee population, along with SCCS-derived IRR, to calculate the expected population-level AR may offer more accurate vaccine risk-benefit assessments.

IntroductionVaccination is critical in controlling the coronavirus disease 19 (COVID-19) pandemic. However, vaccine perception and acceptance among pregnant and lactating women is unknown in Singapore. We aimed to determine the acceptance of COVID-19 vaccination among these two groups of women in Singapore, and factors associated with vaccine acceptance. MethodsWe conducted an anonymous, online survey on the perception and acceptance of the COVID-19 vaccine in pregnant and lactating women at a tertiary hospital in Singapore from 1st March to 31st May 2021. Information on demographics and knowledge were collected, and these factors were assessed for their relationship with vaccine acceptance. ResultsA total of 201 pregnant and 207 lactating women participated. Vaccine acceptance rates in pregnant and lactating women were 30.3% and 16.9% respectively. Pregnant women who were unsure or unwilling to take the vaccine cited concerns about safety of the vaccine during pregnancy (92.9%), while lactating women were concerned about potential long-term negative effects on the breastfeeding child (75.6%). Other factors significantly associated with vaccine acceptance included a lower monthly household income or education level, appropriate knowledge regarding vaccine mechanism and higher perceived maternal risk of COVID-19. Most pregnant (70.0%) and lactating women (83.7%) were willing to take the vaccine only when more safety data during pregnancy and breastfeeding were available. ConclusionsCOVID-19 vaccine acceptance was low among pregnant and lactating women in Singapore. Addressing safety concerns when more data is available and education on mechanism of vaccine action will likely improve acceptance among these women.

BackgroundVaccine-preventable diseases (VPDs) continue to impose a significant health and economic burden globally, despite advances in immunization programs. Narrower to the context of Saudi Arabia, the current literature consistently shows that the high vaccination coverage has had the primary impact of reducing disease incidence. Regardless, the broader economic impact of VPDs and the financial benefits of immunization remain important for policy evaluation within Saudi Arabia. MethodsThis study employed a model-based economic evaluation using a societal perspective in order to carry out an estimation of the economic burden of measles, influenza, and pneumococcal diseases. We utilized the Cost of Illness (COI) approach for the purpose of quantifying direct medical costs and indirect productivity losses. On the other hand, the Value of Statistical Life (VSL) approach helped in the estimation of the monetary value of mortality reduction. A comparative framework analyzed current vaccination coverage against a counterfactual no-vaccination scenario for the calculation of the return on investment (ROI). ResultsThe estimated annual economic burden of the three selected VPDs in the absence of vaccination was USD 385 (95% CI: 315-460) million. Immunization programs generated substantial economic benefits, with total benefits estimated at USD 1085 (95% CI: 815-1360) million annually. The calculated ROI was 9.0 (95% CI: 6.8-11.3), essentially an indication that for each dollar invested in vaccination, there was multiple economic returns yielded. Sensitivity analyses confirmed the robustness of these findings. ConclusionImmunization programs in Saudi Arabia provide significant economic and public health benefits and for this reason, sustained investment in vaccination is fundamentally essential towards the reduction of disease burden, improve population health, and ultimately support long-term economic productivity.

Beginning in early March 2021 and continuing through May 2021, the USAF Academy began vaccinating cadets for protection against the SARS-CoV-2 virus with the BNT162b2 (Pfizer-BioNTech) mRNA vaccine. During this period, vaccination of the almost 4200 cadet population increased from 3% to 85% and prevalence of COVID-19 in the cadet population was constant at approximately 0.4% as indicated by weekly surveillance testing. In this study, vaccine effectiveness at preventing infection is estimated by comparing infection risk as a function of time since vaccination. A statistically significant four-fold reduction in infection risk was observed 14 days after the first vaccine dose and an eleven-fold reduction in infection risk was observed in fully vaccinated cadets. Overall, the Pfizer-BioNTech vaccine was 91% (95% confidence interval = 55-99%) effective at preventing infection in healthy young adults (17-26 years of age) in a university setting and military training environment.

Cervical cancer remains a major public health challenge in Indonesia, with Human Papillomavirus (HPV) infection responsible for nearly all cases. The government has integrated HPV vaccination into the national School Children Immunization Month (BIAS). However, out-of-school (OOS) girls remain difficult to reach because they are not covered by the school-based vaccination platform. Micro-costing approach was used to estimate both economic and financial costs of delivering HPV vaccination to OOS girls in Bekasi City, Bandar Lampung City, and Bangka District. This study aimed to estimate the cost of delivering a single-dose HPV vaccination program to OOS girls and to project the national-level cost of scaling up the program. Costs were categorized into outreach efforts, such as community mobilization and identification of girls, and delivery components including logistics, storage, and administration. A scale-up costing analysis was also conducted to estimate national-level costs. The results show that the cost per vaccinated OOS girl aged 11 ranged from US$ 22.77 to 38.55, while the financial cost range from US$ 12.70 to 29.50, varied by implementation context, with outreach activities, transportation, and vaccine delivery supplies identified as the main cost drivers. The estimated national annual economic and financial cost of scaling-up HPV vaccination for OOS girls are US$ 644,215.23 and US$ 483,138.35, respectively. Our national cost estimates show that reaching and vaccinating OOS girls accounts for less than 3% of the national immunization budget. Factors such as local context and implementation challenges should be recognized as they may directly influence the cost and hinder the program scale-up.

BackgroundMany children do not receive a full schedule of childhood vaccines, yet there is limited evidence on the cost-effectiveness of strategies for improving vaccination coverage. We evaluated the cost-effectiveness of periodic intensification of routine immunization (PIRI), a widely applied strategy for increasing vaccination coverage. MethodsIntensified Mission Indradhanush (IMI) was a large-scale PIRI intervention implemented in India in 2017-2018. In 40 sampled districts, we measured the incremental economic cost of IMI using primary data, and used a quasi-experimental impact evaluation to estimate incremental vaccination doses delivered. We estimated deaths and disability-adjusted life years (DALYs) averted using the Lives Saved Tool and reported cost-effectiveness from government provider and societal perspectives. FindingsIn sampled districts, IMI had an estimated incremental cost of 2021US$15.7 (95% uncertainty interval: 11.9 to 20.1) million from a provider perspective and increased vaccine delivery by an estimated 2.2 (-0.5 to 4.8) million doses, averting an estimated 1,413 (-350 to 3,129) deaths. The incremental cost was $7.14 per dose ($3.20 to dominated), $95.24 per zero-dose child reached ($45.48 to dominated), $375.98 ($168.54 to dominated) per DALY averted, $413.96 ($185.56 to dominated) per life-year saved, and $11,133 ($4,990 to dominated) per under-five death averted. At a cost-effectiveness threshold of 1x per-capita GDP per DALY averted, IMI was estimated to be cost-effective with 89% probability. InterpretationThis evidence suggests IMI was both impactful and cost-effective for improving vaccination coverage. As vaccination programs expand coverage, unit costs may increase due to the higher costs of reaching currently unvaccinated children. FundingBill & Melinda Gates Foundation