Prehospital & Disaster Medicine
Volume 30 – Issue 04 – August 2015
https://journals.cambridge.org/action/displayIssue?jid=PDM&tab=currentissue
Original Research
Pneumonia Prevention during a Humanitarian Emergency: Cost-effectiveness of Haemophilus Influenzae Type B Conjugate Vaccine and Pneumococcal Conjugate Vaccine in Somalia
Lisa M. Garganoa1 c1, Rana Hajjeha2 and Susan T. Cooksona1
a1 Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia USA
a2 Division of Bacterial Diseases, National Center of Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia USA
Abstract
Background Pneumonia is a leading cause of death among children less than five years old during humanitarian emergencies. Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae are the leading causes of bacterial pneumonia. Vaccines for both of these pathogens are available to prevent pneumonia.
Problem This study describes an economic analysis from a publicly funded health care system perspective performed on a birth cohort in Somalia, a country that has experienced a protracted humanitarian emergency.
Methods An impact and cost-effectiveness analysis was performed comparing: no vaccine, Hib vaccine only, pneumococcal conjugate vaccine 10 (PCV10) only, and both together administered through supplemental immunization activities (SIAs). The main summary measure was the incremental cost per disability-adjusted life-years (DALYs) averted. One-way sensitivity analysis was conducted for uncertainty in parameter values.
Results Each SIA would avert a substantial number of cases and deaths. Compared with no vaccine, the DALYs averted by two SIAs for two doses of Hib vaccine was US $202.93 (lower and upper limits: $121.80-$623.52), two doses of PCV10 was US $161.51 ($107.24-$227.21), and two doses of both vaccines was US $152.42 ($101.20-$214.42). Variables that influenced the cost-effectiveness for each strategy most substantially were vaccine effectiveness, case fatality rates (CFRs), and disease burden.
Conclusions The World Health Organization (WHO) defines a cost-effective intervention as costing one to three times the per capita gross domestic product (GDP; in 2011, for Somalia=US $112). Based on the presented model, Hib vaccine alone, PCV10 alone, or Hib vaccine and PCV10 given together in SIAs are cost-effective interventions in Somalia. The WHO/Strategic Advisory Group of Experts decision-making factors for vaccine deployment appear to have all been met: the disease burden is large, the vaccine-related risk is low, prevention in this setting is more feasible than treatment, the vaccine duration probably is sufficient for the vulnerable period of the child’s life, cost is reasonable, and herd immunity is possible.

Original Research
The Development of a Humanitarian Health Ethics Analysis Tool
Veronique Frasera1a2 c1, Matthew R. Hunta3a4, Sonya de Laata5 and Lisa Schwartza6
a1 Centre for Clinical Ethics, St-Joseph’s Health Centre, Toronto, Ontario, Canada
a2 University of Toronto Joint Centre for Bioethics, Toronto, Ontario, Canada
a3 School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
a4 Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
a5 Faculty of Information and Media Studies, Western University, London, Ontario, Canada
a6 Clinical Epidemiology and Biostatics, McMaster University, Hamilton, Ontario, Canada
Abstract
Introduction Health care workers (HCWs) who participate in humanitarian aid work experience a range of ethical challenges in providing care and assistance to communities affected by war, disaster, or extreme poverty. Although there is increasing discussion of ethics in humanitarian health care practice and policy, there are very few resources available for humanitarian workers seeking ethical guidance in the field. To address this knowledge gap, a Humanitarian Health Ethics Analysis Tool (HHEAT) was developed and tested as an action-oriented resource to support humanitarian workers in ethical decision making.
While ethical analysis tools increasingly have become prevalent in a variety of practice contexts over the past two decades, very few of these tools have undergone a process of empirical validation to assess their usefulness for practitioners.
Methods A qualitative study consisting of a series of six case-analysis sessions with 16 humanitarian HCWs was conducted to evaluate and refine the HHEAT.
Results Participant feedback inspired the creation of a simplified and shortened version of the tool and prompted the development of an accompanying handbook.
Conclusion The study generated preliminary insight into the ethical deliberation processes of humanitarian health workers and highlighted different types of ethics support that humanitarian workers might find helpful in supporting the decision-making process.