Pneumococcal Vaccination Cost Effective And Should Substantially Reduce Child Mortality

Routine vaccination of infants against Streptococcus pneumoniae (pneumococcus)* in the world's poorest countries should substantially reduce childhood mortality and be cost effective according to an Article in this week's issue of The Lancet.

Anushua Sinha (Department of Preventive Medicine and Community Health, University of Medicine & Dentistry of New Jersey, Newark, USA) and colleagues constructed a decision analysis model to generate global and country-specific information about the projected benefits, costs, and cost-effectiveness of pneumococcal vaccination of infants aged 6, 10, and 14 weeks in 72 countries that were eligible for Global Alliance for Vaccines and Immunisation (GAVI) support**.

The researchers predicted that without pneumococcal vaccination there would be 3.8 million deaths of children aged 3 - 29 months yearly. Pneumococcal vaccination was projected to prevent 262 000 of these deaths (7%) and avert 8.3 million DALYs*** annually. If vaccination coverage rates in all 72 countries were 100%, 407 000 child deaths would be prevented every year. At a vaccine cost of International $5 per dose, vaccination would have a net cost of $838 million, a cost of $100 per DALY averted.

The authors conclude: "The results of this analysis indicate the vaccine is highly cost effective on the basis of prevention of child mortality alone. Additional savings in medical costs from non-fatal illness, herd immunity, and from sustained protection beyond 29 months would improve the cost effectiveness even further." (Quote by email does not appear in published paper.)

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Dr Anushua Sinha, Department of Preventive Medicine and Community Health, University of Medicine & Dentistry of New Jersey, Newark, USA.

* Pneumonia and other respiratory infections cause about 2 million child deaths every year, the vast majority in developing countries. Most pneumonia deaths are believed to be due to bacterial pneumonia, a common cause of which is Streptococcus pneumoniae. S pneumoniae also causes otitis media, bacteraemia, sepsis, and meningitis in early childhood. Vaccination of infants in the world's poorest countries against S pneumoniae has the potential to prevent many deaths, but would require substantial funding. Experience with other vaccines suggests that, without substantial global investment by governments and charitable organisations, coupled with a coordinated effort, conjugated pneumoccocal vaccines are unlikely to reach children in developing countries during the next decade. Policymakers need detailed information about whether and where to support introduction of a vaccine when considering justification of such an investment.

**Countries with gross national income less than us $1000 per head and meeting other pre-specified criteria.

*** The Disability Adjusted Life Year or DALY is a health gap measure that extends the concept of potential years of life lost due to premature death to include equivalent years of 'healthy' life lost by virtue of being in states of poor health or disability. The DALY combines in one measure the time lived with disability and the time lost due to premature mortality. One DALY can be thought of as one lost year of 'healthy' life and the burden of disease as a measurement of the gap between current health status and an ideal situation where everyone lives into old age free of disease and disability.

Contact: Joe Santangelo
Lancet