scholarly journals Dosing interval strategies for two-dose COVID-19 vaccination in 13 low- and middle-income countries of Europe: health impact modelling and benefit-risk analysis

2021 ◽  
Author(s):  
Yang Liu ◽  
Carl AB Pearson ◽  
Frank G Sandmann ◽  
Rosanna C Barnard ◽  
Jong-Hoon Kim ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Health Impact ◽  
Base Case ◽  
Middle Income ◽  
Dosing Interval ◽  
Middle Income Countries ◽  
Optimal Dosing ◽  
Benefit Risk Assessment ◽  
Dosing Intervals ◽  
Low And Middle Income

Background: In settings where the COVID-19 vaccine supply is constrained, extending the intervals between the first and second doses of the COVID-19 vaccine could let more people receive their first doses earlier. Our aim is to estimate the health impact of COVID-19 vaccination alongside benefit-risk assessment of different dosing intervals for low- and middle-income countries of Europe. Methods: We fitted a dynamic transmission model to country-level daily reported COVID-19 mortality in 13 low- and middle-income countries in the World Health Organization European Region (Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Georgia, Republic of Moldova, Russian Federation, Serbia, North Macedonia, Turkey, and Ukraine). A vaccine product with characteristics similar to the Oxford/AstraZeneca COVID-19 (AZD1222) vaccine was used in the base case scenario and was complemented by sensitivity analyses around efficacies related to other COVID-19 vaccines. Both fixed dosing intervals at 4, 8, 12, 16, and 20 weeks and dose-specific intervals that prioritise specific doses for certain age groups were tested. Optimal intervals minimise COVID-19 mortality between March 2021 and December 2022. We incorporated the emergence of variants of concern into the model, and also conducted a benefit-risk assessment to quantify the trade-off between health benefits versus adverse events following immunisation. Findings: In 12 of the 13 countries, optimal strategies are those that prioritise the first doses among older adults (60+ years) or adults (20-59 years). These strategies lead to dosing intervals longer than six months. In comparison, a four-week fixed dosing interval may incur 10.2% [range: 4.0% - 22.5%; n = 13 (countries)] more deaths. There is generally a negative association between dosing interval and COVID-19 mortality within the range we investigated. Assuming a shorter first dose waning duration of 120 days, as opposed to 360 days in the base case, led to shorter optimal dosing intervals of 8-12 weeks. Benefit-risk ratios were the highest for fixed dosing intervals of 8-12 weeks. Interpretation: We infer that longer dosing intervals of over six months, which are substantially longer than the current label recommendation for most vaccine products, could reduce COVID-19 mortality in low- and middle-income countries of WHO/Europe. Certain vaccine features, such as fast waning of first doses, significantly shorten the optimal dosing intervals.

scholarly journals Estimating the Health Impact of Vaccination Against 10 Pathogens in 98 Low and Middle Income Countries from 2000 to 2030

2019 ◽  
Author(s):  
Xiang Li ◽  
Christinah Mukandavire ◽  
Zulma M. Cucunubá ◽  
Kaja Abbas ◽  
Hannah E. Clapham ◽  
...  
Keyword(s):  
Health Impact ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals Exploring the Potential Health Impact and Cost-Effectiveness of AIDS Vaccine within a Comprehensive HIV/AIDS Response in Low- and Middle-Income Countries

PLoS ONE ◽  
2016 ◽  
Vol 11 (1) ◽  
pp. e0146387 ◽  
Author(s):  
Thomas M. Harmon ◽  
Kevin A. Fisher ◽  
Margaret G. McGlynn ◽  
John Stover ◽  
Mitchell J. Warren ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health Impact ◽  
Potential Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Aids Vaccine ◽  
Low And Middle Income ◽  
Hiv Aids

scholarly journals Estimating the health impact of vaccination against 10 pathogens in 98 low and middle income countries from 2000 to 2030

2019 ◽  
Author(s):  
Xiang Li ◽  
Christinah Mukandavire ◽  
Zulma M Cucunubá ◽  
Kaja Abbas ◽  
Hannah E Clapham ◽  
...  
Keyword(s):  
Hepatitis B ◽  
Birth Cohort ◽  
Vaccine Coverage ◽  
Health Impact ◽  
Childhood Vaccination ◽  
Middle Income ◽  
Middle Income Countries ◽  
Life Years ◽  
The Impact ◽  
Low And Middle Income

AbstractBackgroundThe last two decades have seen substantial expansion of childhood vaccination programmes in low and middle income countries (LMICs). Here we quantify the health impact of these programmes by estimating the deaths and disability-adjusted life years (DALYs) averted by vaccination with ten antigens in 98 LMICs between 2000 and 2030.MethodsIndependent research groups provided model-based disease burden estimates under a range of vaccination coverage scenarios for ten pathogens: hepatitis B (HepB), Haemophilus influenzae type b (Hib), human papillomavirus (HPV), Japanese encephalitis (JE), measles, Neisseria meningitidis serogroup A (MenA), Streptococcus pneumoniae, rotavirus, rubella, yellow fever. Using standardized demographic data and vaccine coverage estimates for routine and supplementary immunization activities, the impact of vaccination programmes on deaths and DALYs was determined by comparing model estimates from the no vaccination counterfactual scenario with those from a default coverage scenario. We present results in two forms: deaths/DALYs averted in a particular calendar year, and in a particular annual birth cohort.FindingsWe estimate that vaccination will have averted 69 (2.5-97.5% quantile range 52-88) million deaths between 2000 and 2030 across the 98 countries and ten pathogens considered, 35 (29-45) million of these between 2000-2018. From 2000-2018, this represents a 44% (36-57%) reduction in deaths due to the ten pathogens relative to the no vaccination counterfactual. Most (96% (93-97%)) of this impact is in under-five age mortality, notably from measles. Over the lifetime of birth cohorts born between 2000 and 2030, we predict that 122 (96-147) million deaths will be averted by vaccination, of which 58 (39-75) and 38 (26-52) million are due to measles and Hepatitis B vaccination, respectively. We estimate that recent increases in vaccine coverage and introductions of additional vaccines will result in a 72% (61-79%) reduction in lifetime mortality caused by these 10 pathogens in the 2018 birth cohort.InterpretationIncreases in vaccine coverage and the introduction of new vaccines into LMICs over the last two decades have had a major impact in reducing mortality. These public health gains are predicted to increase in coming decades if progress in increasing coverage is sustained.

scholarly journals A Systematic Framework for Collecting Site-Specific Sampling and Survey Data to Support Analyses of Health Impacts from Land-Based Pollution in Low- and Middle-Income Countries

2021 ◽  
Vol 18 (9) ◽  
pp. 4676
Author(s):  
Katherine von Stackelberg ◽  
Pamela R.D. Williams ◽  
Ernesto Sánchez-Triana
Keyword(s):  
Health Outcomes ◽  
Health Impact ◽  
Adverse Outcomes ◽  
Health Impacts ◽  
Small Scale ◽  
Economic Activities ◽  
Middle Income ◽  
Middle Income Countries ◽  
Populations At Risk ◽  
Low And Middle Income

The rise of small-scale and localized economic activities in low- and middle-income countries (LMICs) has led to increased exposures to contaminants associated with these processes and the potential for resulting adverse health effects in exposed communities. Risk assessment is the process of building models to predict the probability of adverse outcomes based on concentration-response functions and exposure scenarios for individual contaminants, while epidemiology uses statistical methods to explore associations between potential exposures and observed health outcomes. Neither approach by itself is practical or sufficient for evaluating the magnitude of exposures and health impacts associated with land-based pollution in LMICs. Here we propose a more pragmatic framework for designing representative studies, including uniform sampling guidelines and household surveys, that draws from both methodologies to better support community health impact analyses associated with land-based pollution sources in LMICs. Our primary goal is to explicitly link environmental contamination from land-based pollution associated with specific localized economic activities to community exposures and health outcomes at the household level. The proposed framework was applied to the following three types of industries that are now widespread in many LMICs: artisanal scale gold mining (ASGM), used lead-acid battery recycling (ULAB), and small tanning facilities. For each activity, we develop a generalized conceptual site model (CSM) that describes qualitative linkages from chemical releases or discharges, environmental fate and transport mechanisms, exposure pathways and routes, populations at risk, and health outcomes. This upfront information, which is often overlooked, is essential for delineating the contaminant zone of influence in a community and identifying relevant households for study. We also recommend cost-effective methods for use in LMICs related to environmental sampling, biological monitoring, survey questionnaires, and health outcome measurements at contaminated and unexposed reference sites. Future study designs based on this framework will facilitate consistent, comparable, and standardized community exposure, risk, and health impact assessments for land-based pollution in LMICs. The results of these studies can also support economic burden analyses and risk management decision-making around site cleanup, risk mitigation, and public health education.

scholarly journals Democratic governance and excess mortality during the COVID-19 pandemic

2021 ◽  
Author(s):  
Vageesh Jain ◽  
Jonathan Clarke ◽  
Thomas Beaney
Keyword(s):  
Risk Assessment ◽  
Excess Mortality ◽  
Health Impact ◽  
Democratic Governance ◽  
High Income ◽  
Assessment Tools ◽  
Linear Regression Models ◽  
Middle Income ◽  
The Mean ◽  
Low And Middle Income

Background Excess mortality has been used to assess the health impact of COVID-19 across countries. Democracies aim to build trust in government and enable checks and balances on decision-making, which may be useful in a pandemic. On the other hand, democratic governments have been criticised as slow to enforce restrictive policies and being overly influenced by public opinion. This study sought to understand whether the strength of democratic governance is associated with the variation in excess mortality observed across countries during the pandemic. Methods Through linking open-access datasets we constructed univariable and multivariable linear regression models investigating the association between country EIU Democracy Index (representing the strength of democratic governance on a scale of 0 to 10) and excess mortality rates, from February 2020 to May 2021. We stratified our analysis into high-income and low and middle-income country groups and adjusted for several important confounders. Results Across 78 countries, the mean EIU democracy index was 6.74 (range 1.94 to 9.81) and the mean excess mortality rate was 128 per 100,000 (range -55 to 503 per 100,000). A one-point increase in EIU Democracy Index was associated with a decrease in excess mortality of 26.3 per 100,000 (p=0.002), after accounting for COVID-19 cases, age 65+, gender, prevalence of cardiovascular disease, universal health coverage and the strength of early government restrictions. This association was particularly strong in high-income countries (b=-47.5, p<0.001) but non-significant in low and middle-income countries (b=-10.8, p=0.40). Conclusions Socio-political factors related to the way societies are governed have played an important role in mitigating the overall health impact of COVID-19. Given the omission of such considerations from outbreak risk assessment tools, and their particular significance in high-income countries rated most highly by such tools, this study strengthens the case to broaden the scope of traditional pandemic risk assessment.

scholarly journals The Health Impact Fund: making the case for engagement with pharmaceutical laboratories in Brazil, Russia, India, and China

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Vivian Chia-Jou Lee ◽  
Jacqueline Yao ◽  
William Zhang
Keyword(s):  
Research And Development ◽  
Health Impact ◽  
High Income ◽  
Neglected Diseases ◽  
Pharmaceutical Companies ◽  
Middle Income ◽  
Middle Income Countries ◽  
Bric Countries ◽  
India And China ◽  
Low And Middle Income

AbstractDespite progress in global health, the general disease burden still disproportionately falls on low- and middle-income countries. The health needs of these countries’ populations are unmet because there is a shortage in drug research and development, as well as a lack of access to essential drugs. This health disparity is especially problematic for diseases associated with poverty, namely neglected tropical diseases and microbial infections. Currently, the pharmaceutical landscape focuses on innovations determined by profit margins and intellectual property protection. To expand drug accessibility and catalyze research and development for neglected diseases, a team of researchers proposed the Health Impact Fund as a potential solution. However, the fund is predominantly considering partnerships with pharmaceutical giants in high-income countries. This commentary explores the limitations and benefits in partnering with pharmaceutical companies based in Brazil, Russia, India, and China (BRIC), with the goal of expanding the Health Impact Fund’s vision to incorporate long-term, local partnerships. Identified limitations to a BRIC country partnership include lower levels of drug development expertise compared to their high-income pharmaceutical counterparts, and whether the Health Impact Fund and the participating stakeholders have the financial capability to assist in bringing a new drug to market. However, potential benefits include the creation of new incentives to fuel competitive local innovation, more equitable routes to drug discovery and development, and a product pipeline that could involve stakeholders in lower- and middle-income countries. Our commentary explores how partnership with pharmaceutical firms in BRIC countries might be advantageous for all: The Health Impact Fund, pharmaceutical companies in BRIC economies, and stakeholders in low- and middle- income countries.

scholarly journals Systematic Literature Review of Health Impact Assessments in Low and Middle-Income Countries

2019 ◽  
Vol 16 (11) ◽  
pp. 2018 ◽  
Author(s):  
Meelan Thondoo ◽  
David Rojas-Rueda ◽  
Joyeeta Gupta ◽  
Daniel H. de Vries ◽  
Mark J. Nieuwenhuijsen
Keyword(s):  
Air Pollution ◽  
Process Evaluation ◽  
Latin American ◽  
Health Impact ◽  
Middle Income ◽  
Unequal Distribution ◽  
Reporting Practices ◽  
Middle Income Countries ◽  
Health Impact Assessments ◽  
Low And Middle Income

Health Impact Assessments (HIAs) motivate effective measures for safeguarding public health. There is consensus that HIAs in low and middle-income countries (LMICs) are lacking, but no study systematically focuses on those that have been successfully conducted across all regions of the world, nor do they highlight factors that may enable or hinder their implementation. Our objectives are to (1) systematically review, geographically map, and characterize HIA activity in LMICs; and (2) apply a process evaluation method to identify factors which are important to improve HIA implementation in LMICs. A systematic review of peer-reviewed HIAs in 156 LMICs was performed in Scopus, Medline, Web of Science, Sociological abstracts, and LILACs (Latin American and Caribbean Health Sciences) databases. The search used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and covered HIAs across all type of interventions, topics, and health outcomes. HIAs were included if they reported a clear intervention and health outcome to be assessed. No time restriction was applied, and grey literature was not included. The eligible studies were subjected to six process evaluation criteria. The search yielded 3178 hits and 57 studies were retained. HIAs were conducted in 26 out of 156 countries. There was an unequal distribution of HIAs across regions and within LMICs countries. The leading topics of HIA in LMICs were air pollution, development projects, and urban transport planning. Most of the HIAs reported quantitative approaches (72%), focused on air pollution (46%), appraised policies (60%), and were conducted at the city level (36%). The process evaluation showed important variations in the way HIAs have been conducted and low uniformity in the reporting of six criteria. No study reported the time, money, and staff used to perform HIAs. Only 12% of HIAs were based on participatory approaches; 92% of HIAs considered multiple outcomes; and 61% of HIAs provided recommendations and fostered cross-national collaboration. The limited transparency in process, weak participation, and inconsistent delivery of recommendations were potential limitations to HIA implementation in low and middle-income countries. Scaling and improving HIA implementation in low and middle-income countries in the upcoming years will depend on expanding geographically by increasing HIA governance, adapting models and tools in quantitative methods, and adopting better reporting practices.

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