Estimating deaths averted and cost per life saved by scaling up mRNA COVID-19 vaccination in low-income and lower-middle-income countries in the COVID-19 Omicron variant era: a modelling study

Abstract

Objectives: While almost 60% of the world has received at least one dose of COVID-19 vaccine, the global distribution of vaccination has not been equitable. Only 4% of the population of low-income countries (LICs) has received a full primary vaccine series, compared with over 70% of the population of high-income nations.

Design: We used economic and epidemiological models, parameterised with public data on global vaccination and COVID-19 deaths, to estimate the potential benefits of scaling up vaccination programmes in LICs and lower-middle-income countries (LMICs) in 2022 in the context of global spread of the Omicron variant of SARS-CoV2.

Setting: Low-income and lower-middle-income nations.

Main outcome measures: Outcomes were expressed as number of avertable deaths through vaccination, costs of scale-up and cost per death averted. We conducted sensitivity analyses over a wide range of parameter estimates to account for uncertainty around key inputs.

Findings: Globally, universal vaccination in LIC/LMIC with three doses of an mRNA vaccine would result in an estimated 1.5 million COVID-19 deaths averted with a total estimated cost of US$61 billion and an estimated cost-per-COVID-19 death averted of US$40 800 (sensitivity analysis range: US$7400-US$81 500). Lower estimated infection fatality ratios, higher cost-per-dose and lower vaccine effectiveness or uptake lead to higher cost-per-death averted estimates in the analysis.

Conclusions: Scaling up COVID-19 global vaccination would avert millions of COVID-19 deaths and represents a reasonable investment in the context of the value of a statistical life. Given the magnitude of expected mortality facing LIC/LMIC without vaccination, this effort should be an urgent priority.

Keywords: COVID-19; HEALTH ECONOMICS; Public health.

Figure 1

Sensitivity analysis looking at cost-per-death averted of vaccination in LIC/LMIC, ranging cost per vaccine dose, IFR and vaccine effectiveness against mortality in the two-dose scenario (first panel) and three-dose scenario (second panel). The y-axis shows cost-per-death averted in US$, the x-axis shows cost per dose of vaccine in US$. Solid lines show IFR of 5/10 000, dotted line shows IFR of 1/10 000, and dashed lines show IFR of 5/1000. Dark red lines show baseline vaccine effectiveness (80% in two-dose scenario and 90% in three-dose scenario), and dark blue lines show high vaccine effectiveness (95% in two-dose scenario and 99% in three-dose scenario). IFR, infection fatality ratio; LIC, low-income country; LMIC, lower-middle income country.

Figure 2

Sensitivity analysis looking at deaths averted of vaccination LIC/LMIC, ranging IFR and vaccine effectiveness against mortality in the two-dose scenario (first panel) and three-dose scenario (second panel). The y-axis shows deaths averted, in millions. The x-axis shows IFR. dark red lines show baseline vaccine effectiveness (80% in two-dose scenario and 90% in three-dose scenario), and dark blue lines show high vaccine effectiveness (95% in two-dose scenario and 99% in three-dose scenario). IFR, infection fatality ratio; LIC, low-income country; LMIC, lower-middle income country.