Funding COVID-19 Vaccination in Low-and Middle-Income Countries is Highly Cost Effective and Projected to Save Hundreds of Thousands of Lives

BOSTON – Because the benefits of vaccines to prevent COVID-19 have largely been confined to high- and upper-middle-income countries, the COVAX Advance Market Commitment program has been raising funds and delivering SARS-CoV-2 vaccines to low- and middle-income countries (LMICs).

The hope is to reduce morbidity and mortality, stem economic losses from epidemic-related disruptions, and potentially reduce the risk of new variants emerging.

A new analysis led by researchers at Massachusetts General Hospital (MGH) and published in The Journal of Infectious Diseases indicates that funding expanded COVID-19 vaccine delivery in LMICs would save hundreds of thousands of lives, be similarly or more cost-effective than other donor-funded global aid programs, and improve health equity.

“The rapid development of COVID-19 vaccines was a huge biomedical success but the delivery of those vaccines worldwide remains extremely inequitable. For example, as of now, only 14% of people in low-income countries have received a primary vaccination course compared with nearly 75% of people in upper-middle- and high-income countries,” says lead author Mark J. Siedner, MD, MPH, an infectious disease clinician and researcher in the Division of Infectious Diseases at MGH.

“Many have called for action to close that gap, but how much benefit would closing this gap provide? And at what cost to donors who fund the effort? Our goal was to determine the value from the donor perspective of increasing vaccination in LMICs and reducing global vaccine inequity.”

Siedner and his colleagues used a mathematical model to project the health benefits (in terms of infections and deaths prevented) and donor costs of purchasing and delivering SARS-CoV-2 vaccines to 91 LMICs, modeling both a highly contagious, lower-severity “omicron-like” variant, a similarly contagious variant, and a more severe variant over 360 days.

Costs included a vaccination startup of $630 million and a per-person procurement and delivery amount of $12.46 per person.

In the omicron-like scenario, increasing current vaccination coverage to achieve at least 15% of the population vaccinated in each of the 91 LMICs would prevent 11 million new infections and 120,000 deaths over one year, at a cost of $0.95 billion, translating to a cost-effectiveness estimate of $670 per each year-of-life saved from vaccination.

Increases in vaccination coverage to 60% of countries’ populations would additionally prevent up to 68 million infections and 160,000 deaths, translating to less than $8,000 per year-of-life saved. Under the more severe variant scenario, the value of vaccination was even better: the cost would be less than $4,000 per year-of-life saved for achieving 60% coverage.

While there is no universally accepted cost-effectiveness threshold to determine the value for donor countries investing on behalf of LMICs, the findings in this analysis suggest that COVID-19 vaccination would be as or substantially more cost-effective than other donor-financed public health measures in LMICs, such as the global delivery of antiretroviral therapy for HIV through the US President’s Emergency Plan for AIDS Relief (PEPFAR).

This total amount to fund at least 45% of the vaccine supply to all of the 91 LMICs would represent about 0.4% of the US government’s investment in the domestic COVID-19 response to date. 

“These findings should provide donor countries and organizations—such as the WHO, UNICEF, Gavi, and CEPI—with needed data to reinforce the value and significant benefit of urgently expanding COVID-19 vaccine access in LMICs,” says co-author Christopher Alba, BS, a researcher at MGH.

Alba added that the model helps demonstrate both health benefits and value, and does not even account for many additional benefits of global vaccination campaigns, such as reducing domestic COVID-19 healthcare spending, reducing long-COVID complications, and reducing the risk of additional viral variants emerging.

“As public health leaders focus on how to best increase global vaccine access, we believe that these findings highlight that reducing vaccine inequity provides critically important health benefits, and is cost-effective at the same time,” notes Kenneth Freedberg, MD, MSc, senior author of the study and director of the MGH Medical Practice Evaluation Center.

Additional study co-authors include Kieran P. Fitzmaurice, BS, Rebecca F. Gilbert, BA, Justine A. Scott, MPH, Fatma M. Shebl, MD, MPH, Andrea Ciaranello, MD, MPH, and Krishna P. Reddy, MD, MS.

This work was supported by the U.S. National Institutes of Health.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2021, Mass General was named #5 in the U.S. News & World Report list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system.