Are expensive vaccines the best investment in low-income and middle-income countries?

Lancet Global Health
Apr 2019 Volume 7Number 4e385-e532

Are expensive vaccines the best investment in low-income and middle-income countries?
Lone Simonsen, Maarten van Wijhe, Robert Taylor
[Initial text]
In a new study in The Lancet Global Health, John Ojal and colleagues project that the use of ten-valent pneumococcal conjugate vaccine (PCV10) will be cost-effective in Kenya after international donor support for vaccine programmes ends in around 2027. Until now, Kenya has relied on funding from Gavi, the international vaccine alliance, to fund its PCV programme. But because Gavi withdraws support from countries as their economies grow, Kenya will have to bear the full $9 per child cost for a three-dose course of PCVs starting in 2027. For Kenya, where annual per capita actual expenditure for health is around $70 (about 5% of GDP), that is not a trivial cost.
Kenya is not alone in having to decide whether expensive vaccines are worth the money, as many other lower-middle-income countries with growing economies will soon lose international support. For these countries, careful evaluation of the cost-effectiveness and affordability of such programmes, and how they hold up against alternative investments in population health, are essential. The current study is a much-appreciated effort to provide important insights to countries around the world as they struggle to decide how best to spend scarce resources…