Mark Jit

Chair and Professor of the Department of Global and Environmental Health

Professional overview

Mark Jit is the inaugural chair and a professor in the Department of Global and Environmental Health. He was formerly head of the Department of Infectious Disease Epidemiology & Dynamics and co-director of the Global Health Economics Centre (GHECO) at the London School of Hygiene & Tropical Medicine (LSHTM). He holds honorary appointments at LSHTM as well as the University of Hong Kong (HKU) and the National University of Singapore (NUS).

Dr. Jit’s research focuses on epidemiological and economic modeling of vaccines to support evidence-based public health decision making. He has published papers covering a range of vaccine-preventable or potentially vaccine-preventable diseases including COVID-19, measles, HPV, pneumococcus, rotavirus, influenza, Group B Streptococcus, dengue, EV71 and RSV as well as methodological papers advancing the ways vaccines are evaluated. This work has influenced many of the major changes to immunization policy in countries around the world. Dr. Jit has served on a number of expert advisory committees in the UK as well as for international organizations such as the World Health Organization. He also organises or contributes to academic and professional courses on vaccine modeling, economics and decision science around the world.

Dr. Jit received his BSc and PhD in Mathematics from University College London, specializing in mathematical biology, and a Master of Public Health degree from King’s College London.

Visit Dr. Jit's Google Scholar's page to learn more about his research portfolio.

Education

BSc, Mathematics, University College London

PhD, Mathematics, University College London

MPH, Public Health, King's College London

Honors and awards

Clarivate Highly Cited Researcher (20222023)

Fellow of the Academy of Medical Sciences (2023)

Training Fund Award, Health Protection Agency (2007)

Andrew Rosen Prize, University College London (1999)

Institute of Mathematics and its Applications Award (1998)

Departmental Research Studentship, University College London (1998)

Student Union Commendation, University College London (1997)

Fillon Prize, University College London (1996)

Pathfinder Award, University College London (1995)

Publications

Publications

A systematised review and evidence synthesis on the broader societal impact of vaccines against Salmonella

Demirtas, E. D., Barnard, R., Lee, J., & Jit, M. (n.d.).

Publication year

2025

Journal title

npj Vaccines

Volume

10

Issue

1

10.1038/s41541-024-01034-4

Abstract

Abstract

Vaccines against Salmonella Typhi are available, while vaccines against invasive non-typhoidal Salmonella are in development. Investments in vaccine development and introduction need to be informed by a full value of vaccines assessment, including consideration of broader societal impacts of salmonellae disease. We reviewed literature on these broader impacts in low- and middle-income countries to inform a conceptual framework. We found 16 studies relevant to Salmonella, but only one study on non-typhoidal Salmonella. Despite variations in study design, methodology, and study quality, salmonellae infections were largely associated with negative broader societal impacts, including detriments in childhood physical development (very weak association), childhood educational development (strong to very strong association), household security (moderate association), public health spending (moderate association), and national income (moderate to strong association). Study quality was low for all impacts except childhood physical development. There were no studies measuring economic impact of antimicrobial resistance, changes in household behaviour or health inequalities.

A vaccine chatbot intervention for parents to improve HPV vaccination uptake among middle school girls: a cluster randomized trial

Hou, Z., Wu, Z., Qu, Z., Gong, L., Peng, H., Jit, M., Larson, H. J., Wu, J. T., & Lin, L. (n.d.).

Publication year

2025

Journal title

Nature Medicine

Volume

31

Issue

6

Page(s)

1855-1862

10.1038/s41591-025-03618-6

Abstract

Abstract

Conversational artificial intelligence, in the form of chatbots powered by large language models, offers a new approach to facilitating human-like interactions, yet its efficacy in enhancing vaccination uptake remains under-investigated. This study assesses the effectiveness of a vaccine chatbot in improving human papillomavirus (HPV) vaccination among female middle school students aged 12–15 years across diverse socioeconomic settings in China, where HPV vaccination is primarily paid out-of-pocket. A school-based cluster randomized trial was conducted from 18 January to 31 May 2024. The study included 2,671 parents from 180 middle school classes stratified by socioeconomic setting, school and grade level in Shanghai megacity, and urban and rural regions of Anhui Province. Participants were randomly assigned to either the intervention group (90 classes, 1,294 parents), which engaged with the chatbot for two weeks, or the control group (90 classes, 1,377 parents), which received usual care. The primary outcome was the receipt or scheduled appointment of the HPV vaccine for participants’ daughters. In intention-to-treat analyses, 7.1% of the intervention group met this outcome versus 1.8% of the control group (P < 0.001) over a two-week intervention period. In addition, there was a statistically significant increase in HPV vaccination-specific consultations with health professionals (49.1% versus 17.6%, P < 0.001), along with enhanced vaccine literacy (P < 0.001) and rumor discernment (P < 0.001) among participants using the chatbot. These findings indicate that the chatbot effectively increased vaccination and improved parental vaccine literacy, although further research is necessary to scale and sustain these gains. Clinical trial registration: NCT06227689.

Cost-effectiveness analysis of switching from a bivalent to a nonavalent HPV vaccination programme in China: a modelling study

Gao, M., Hu, S., Zhao, X., You, T., Hong, Y., Liu, Y., Qiao, Y., Jit, M., Zhao, F., & Wang, C. (n.d.).

Publication year

2025

Journal title

The Lancet Regional Health - Western Pacific

Volume

56

10.1016/j.lanwpc.2025.101499

Abstract

Abstract

Background: Several domestically-manufactured nonavalent HPV vaccine candidates are in phase III clinical trials and their future availability may address the current dilemma of insufficient supply and high price of the overseas-manufactured nonavalent HPV vaccine in China. We compare the population-level effectiveness and cost-effectiveness of switching to nonavalent HPV vaccination in China. Methods: We used a previously validated transmission model to project the lifetime costs and effectiveness of five same-vaccine and two mixed-vaccine strategies. Nonavalent HPV vaccines were assumed to be available and meet the production requirements for national vaccination between 2030 and 2050. All women living or projected to be born in China during 2023–2100 were considered. We adopted a societal perspective and determined optimal strategies using cost-effectiveness efficiency frontiers. Findings: Under our pricing assumptions, switching to nonavalent vaccination was always cost-saving compared with maintaining the current bivalent vaccination programme, irrespective of the screening scenarios and the year when nonavalent vaccine was assumed to become available (status quo screening: net cost saving $2589–5211 million; improved screening: net cost saving $1852–3789 million). In the same-vaccine strategies, the optimal strategy changed from “routine nonavalent HPV vaccination with catch-up to age 18” to “switching from bivalent to nonavalent HPV vaccination” if nonavalent vaccination is available after 2035. Compared with the optimal same-vaccine strategy, adopting mixed schedules with bivalent and nonavalent vaccines would further save $1336–4280 million net costs and gain 87,000–833,000 QALYs, depending on the screening scenario and the year when nonavalent vaccine becomes available. Interpretation: Switching from bivalent to nonavalent HPV vaccination is likely to be cost-saving and have a significant impact on reducing the cervical cancer burden in China. Funding: Bill & Melinda Gates Foundation (INV-031449 and INV-003174) and CAMS Innovation Fund for Medical Sciences (CIFMS) (2021-I2M-1-004).

Effect of a pay‑it‑forward strategy on reducing HPV vaccine delay and increasing uptake among 15‑ to 18‑year‑old girls in China: A randomized controlled trial

Li, J., Li, Y., Qin, C., He, Y., Lu, H., Xie, Y., Ong, J. J., Lu, Y., Yang, Y., Yang, F., Du, H., Gong, W., Zou, F., Larson, H. J., Jit, M., Lin, L., Smith, J. S., Geng, E. H., Xu, D., … Wu, D. (n.d.).

Publication year

2025

Journal title

PLoS Medicine

Volume

22

Issue

7

10.1371/journal.pmed.1004535

Abstract

Abstract

Background Catch-up human papillomavirus (HPV) vaccination is challenging in many low- and middle-income countries (LMICs). Pay-it-forward offers an individual a subsidized vaccine, then an opportunity to donate to help others access vaccinations. Our randomized control trial assessed the effectiveness of pay-it-forward in improving HPV vaccination among girls aged 15–18 years in China. Methods and findings This study was conducted from July 6, 2022, to June 9, 2023, in four community health centers (CHCs) in Chengdu, western China. Eligible participants were unvaccinated girls living in the service areas of CHCs. Participants were initially recruited via telephone and, after providing verbal consent, attended in-person visit where they were randomly assigned using the sealed envelope method to either the pay-it-forward arm (received a community subsidy of 47.7 USD covering the first vaccine and an opportunity to support others) or control arm (self-paid vaccination at the market price). Participants were unblinded only after the envelope was opened, while the CHC staff coordinators, physicians prescribing the vaccine, outcome assessors, and data analysts were blinded to the intervention allocation. The primary outcome was the first-dose HPV vaccination rate, verified against clinical records. Data were analyzed using the intention-to-treat approach. We identified 662 participants per phone invitation. A total of 321 participants showed up in the health centers and randomly assigned to the pay-it-forward arm (n=161) or control arm (n=160). Most caregivers were female (80.1%, 257/321). In the pay-it-forward arm, 55 of 161 (34.2%) girls received the HPV vaccine, compared with 28 of 160 (17.5%) girls in the control arm (adjusted proportion difference=17.9%, (95% CI [8.7%, 27.0%]; P<0.001). Among 55 girls in the pay-it-forward arm who received the vaccination, 37 (67.3%) wrote a postcard message, and 39 (70.9%) of their caregivers donated to support future girls. The financial cost per person vaccinated was $294 in the control arm and $230 in the pay-it-forward arm. The trial had several limitations, including a 54% clinic attendance rate (360 of 662 consented participants attended) and its conduct in a single western province of China. Conclusions The pro-social pay-it-forward strategy was effective to increase catch-up HPV vaccination among teenage girls. This approach also enhanced vaccine confidence among participants. Pay-it-forward demonstrates promise as an effective intervention to improve vaccine uptake through community engagement.

Factors determining the overlap between recipients of the first and second dose of measles vaccine in nineteen surveys

Papadopoulos, T., Jit, M., Ferrari, M. J., & Vynnycky, E. (n.d.).

Publication year

2025

Journal title

Scientific reports

Volume

15

Issue

1

10.1038/s41598-025-10678-8

Abstract

Abstract

Many countries schedule a second dose of measles-containing vaccine (MCV2) for children in their second year of life. The correlation between recipients of the first dose of measles-containing vaccine (MCV1) and MCV2 is poorly understood but is important for estimating population levels of measles immunity and for meeting elimination targets. Using data from 19 surveys from Demographic and Health Surveys (DHS) we computed the percentage of MCV1 recipients with subsequent MCV2 and of MCV2 recipients with previous MCV1. All countries included in our study recommended MCV1 in the first year of life and MCV2 in the second year of life. For 2 surveys we computed the variation of those percentages over the country’s geographical regions. We computed adjusted odds ratios for the association of this percentage with age, sex, residency, mother’s education, wealth and birth order. For most of the surveys, over 50% of MCV1 recipients received MCV2, but there was more than 30% MCV1 to MCV2 dropout in more than half of the surveys. The percentage of MCV1 recipients with MCV2 was statistically significantly higher if they received MCV1 below age 12 months and the percentage increased with increasing education status of the mother and higher income levels. A small number of MCV2 recipients were not found to have received MCV1, despite marked on record as having received MCV2 implies having previously received MCV1 (by definition of the survey data collection methodology). Our analyses have highlighted important shortfalls by age, country, mother’s education and income status in the proportion of MCV1 recipients who subsequently receive MCV2. Targeting those differentials is essential for achieving the goals of measles elimination.

Fitting dynamic measles models to subnational case notification data from Ethiopia: Methodological challenges and key considerations

Sbarra, A. N., Haeuser, E., Kidane, S., Abate, A., Abebe, A. M., Ahmed, M., Alemayehu, T., Amsalu, E., Aravkin, A. Y., Asgedom, A. A., Bayleyegn, N., Dagnew, M., Demisse, B., Etafa, W., Fetensa, G., Gebremeskel, T. G., Geremew, H., Gizaw, A. T., Hunde, G. A., … Mosser, J. F. (n.d.).

Publication year

2025

Journal title

PLoS computational biology

Volume

21

Issue

4

10.1371/journal.pcbi.1012922

Abstract

Abstract

In many settings, ongoing measles transmission is maintained due to pockets of un- or under-vaccinated individuals even if the critical vaccination threshold is reached nationwide. Therefore, assessing the underlying gaps in measles susceptibility within a population is essential for vaccination programs and measles control efforts. Recently, there have been increased efforts to use geospatial and small area methods to estimate subnational measles vaccination coverage in high-burden settings, such as in Ethiopia. However, the distribution of remaining susceptible individuals, either unvaccinated or having never previously been infected, across age groups and subnational geographies is unknown. In this study, we developed a dynamic transmission model that incorporates geospatial estimates of routine measles vaccination coverage, available data on supplemental immunization activities, and reported cases to estimate measles incidence and susceptibility across time, age, and space. We use gridded population estimates and subnational estimates of routine and supplemental measles vaccination coverage. To account for mixing between age-groups, we used a synthetic contact matrix, and travel times via a friction surface were used in a modified gravity model to account for spatial movement. We explored model fitting using Ethiopia as a case study. To address data-related and statistical challenges, we investigated a range of model parameterization and possible fitting algorithms. The approach with the best performance was a model fitted to case notifications adjusted for case ascertainment by using maximum likelihood estimation with block coordinate descent. This strategy was chosen because many data observations (and likely presence of unquantified uncertainty) yielded a steep likelihood surface, which was challenging to fit using Bayesian approaches. We ran sensitivity analyses to explore variations in vaccine effectiveness and compared patterns of susceptibility across space, time, and age. Substantial heterogeneity in reported measles cases as well as susceptibility persists across ages and second-administrative units. These methods and estimates could contribute towards tailored subnational and local planning to reduce preventable measles burden. However, computational and data challenges would need to be addressed for these methods to be applied on a large scale.

Global socioeconomic inequalities in vaccination coverage, supply, and confidence

Wang, Q., Leung, K., Jit, M., Wu, J. T., & Lin, L. (n.d.).

Publication year

2025

Journal title

npj Vaccines

Volume

10

Issue

1

10.1038/s41541-025-01143-8

Abstract

Abstract

Sustainable Development Goal (SDG) adopted in 2015 aim to reduce inequalities and achieve universal health coverage, including access to essential vaccines for all. Using data from WHO, the Vaccine Confidence Project™, World Bank, and UNDP, we analyzed between-country inequalities in coverage of four vaccines (DTP1, DTP3, MCV1, and POL3), vaccine stock-outs, and vaccine confidence. Economic- and education-related inequalities in coverage (measured by the concentration index) declined from 2015 to 2019, increased in 2020, peaked in 2021, and have declined again since 2022. Inequalities increased continuously in the Region of the Americas. Over 2015–2022, 94 countries/territories reported at least one national level DTP-containing vaccine stock-out. Countries/territories with higher income or education attainment showed lower vaccine confidence. Our study underscores the decrease of inequalities in vaccination coverage following the SDG adoption in most regions, and emphasizes the need to address vaccine stock-outs and strength the vaccine confidence.

Health impact and economic evaluation of the Expanded Program on Immunization in China from 1974 to 2024: a modelling study

Wang, C., Lai, X., Abbas, K., Pouwels, K. B., Zhang, H., Jit, M., & Fang, H. (n.d.).

Publication year

2025

Journal title

The Lancet Public Health

10.1016/S2468-2667(25)00039-8

Abstract

Abstract

Background: The Expanded Program on Immunization (EPI), initiated by WHO in 1974, is a cornerstone of public health. China's EPI covers more than a sixth of the world's population and includes eight routine vaccines with high coverage rates. This study aimed to estimate health and economic impacts of China's EPI over the past 50 years (1974–2024). Methods: This study mathematically modelled the impact of all eight routine vaccines in China's EPI against eight pathogens (measles, pertussis, hepatitis B, tuberculosis, hepatitis A, Japanese encephalitis, meningitis A, and poliomyelitis) based on data availability and their substantial disease burden, particularly accounting for non-linearities in vaccine impact. Health and economic outcomes were determined using mathematical models between a counterfactual scenario without vaccination (vaccine coverage set to zero) and the current vaccination scenario (routine vaccination scheduled at age 0–6 years), based on calendar year and birth cohort approaches. The health impact of China's EPI from 1974 to 2024 was measured in the number of cases, deaths, and disability-adjusted life-years (DALYs) averted. Findings: We estimated that China's EPI averted 703·02 million cases (95% credible interval 699·51–722·80) and 2·48 million deaths (2·14–2·97) in 1974–2024 based on the calendar year approach, equivalent to averting an estimated 160·22 million DALYs (145·05–196·99). Using the birth cohort approach, we predicted 707·41 million cases (703·93–727·03) and 7·01 million deaths (6·95–7·87) averted over the lifetime, corresponding to 279·02 million DALYs (265·78–316·12). From a societal perspective, the aggregated cost of vaccination was estimated to be US$124·06 billion (120·49–127·49), although the benefits amounted to $2417·85 billion (2359·38–2710·35). China's EPI yielded an aggregate benefit–cost ratio of 19·48 (18·82–22·08) from the societal perspective and 8·02 (7·64–8·80) from the provider's perspective. Interpretation: China's EPI has shown remarkable health and economic achievements, contributing to worldwide EPI success in the past 50 years. Further investment in EPI is warranted to sustain coverage and expand vaccine inclusion in China and globally. Funding: Beijing Natural Science Foundation. Translation: For the Chinese translation of the abstract see Supplementary Materials section.

Identification and sizing of the current use cases for seasonal influenza vaccines

Soble, A., Malhame, M., Malvolti, S., Mantel, C., Jit, M., Koh, M., Lambach, P., & Bresee, J. (n.d.).

Publication year

2025

Journal title

Vaccine

Volume

60

10.1016/j.vaccine.2025.127233

Abstract

Abstract

Introduction: Influenza disease continues to have significant global burden. Despite broader use of seasonal influenza vaccines in high resource settings, our understanding of use cases for seasonal influenza vaccines, their relative size, and their relationship to the barriers to adoption in different populations and settings, is limited. This study is a first attempt to identify the use cases for seasonal influenza vaccines to support the design of global influenza vaccination strategies that are better tailored to different implementation contexts and the development of improved influenza vaccines that are more aligned with the different user needs. Methods: By applying a design-based user-centric approach, we implemented a process, including a desk review, a survey, and interviews, to define the current use cases for seasonal influenza vaccines. Results: Nine use cases have been identified as relevant across all different countries and immunization programme designs and validated by experts. Discussion: The identified use cases of seasonal influenza vaccines can support the optimization of vaccination programmes to increase their public health impact. The use cases identified through this work can help signal to policymakers the most important populations and delivery channels to increase the impact of seasonal influenza vaccination programmes and help estimate programmatic requirements necessary for the supportive policy recommendations. The use cases can also support the design of measures aimed at increasing access in low resource settings and coverage in settings where seasonal vaccines are widely used. The use cases can also help to inform the development, of improved influenza vaccines by highlighting the specific product characteristics relevant to their most impactful uses in different programmatic settings.

Influential drivers of the cost-effectiveness of respiratory syncytial virus vaccination in European older adults: a multi-country analysis

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Publication year

2025

Journal title

BMC Medicine

Volume

23

Issue

1

10.1186/s12916-025-03970-x

Abstract

Abstract

Background: We aimed to identify influential drivers of the cost-effectiveness of older adult respiratory syncytial virus (RSV) vaccination in Denmark, Finland, the Netherlands and Valencia-Spain. Methods: A static multi-cohort model was parameterised using country- and age-specific hospitalisations using three approaches: (A) the International Classification of Diseases (ICD)-coded hospitalisations, (B) laboratory RSV-confirmed hospitalisations and (C) time-series modelling (TSM). Plausible hypothetical RSV vaccine characteristics were derived from two protein subunit vaccines for adults aged ≥60 years. A full incremental analysis was conducted by comparing three RSV vaccination strategies: (1) in adults aged ≥60 years (“60y+”); (2) in adults aged ≥65 years (“65y+”); (3) in adults aged ≥75 years (“75y+”) to “no intervention” and to each other. Both costs and quality-adjusted life-years (QALYs) were discounted at country-specific discount rates and the analysis was conducted from both the healthcare payers’ and societal perspectives. Value of information, probabilistic sensitivity and scenario analyses identified influential drivers. Results: Besides vaccine price, the hospitalisation estimates were most influential: (A) Using adjusted RSV-ICD-coded hospitalisations at a vaccine price of €150 per dose, no intervention was cost-effective up to willingness-to-pay (WTP) values of €150,000 per QALY gained in Denmark and the Netherlands, and up to €124,000 per QALY gained in Finland. (B) Using the adjusted RSV-confirmed dataset, the findings were consistent in Denmark and comparable in Finland. In Spain-Valencia, the 75y+ strategy became cost-effective at WTP >€55,000. (C) Using TSM-based estimates, the 75y+ strategy was cost-effective at WTP >€45,000, >€101,000, >€41,000 and >€114,000 in Denmark, Finland, the Netherlands and Spain-Valencia, respectively. Sensitivity analyses showed that the (in-hospital) case fatality ratio and the specification of its age dependency were both influential. Duration of protection was found more influential than a variety of plausible waning patterns over the duration of protection. Conclusions: Data gaps and uncertainties on the RSV-related burden in older adults persist and influence the cost-effectiveness of RSV vaccination. More refined age- and country-specific data on the RSV attributable burden are crucial to aid decision making.

Population-Wide Depression Incidence Forecasting Comparing Autoregressive Integrated Moving Average and Vector Autoregressive Integrated Moving Average to Temporal Fusion Transformers: Longitudinal Observational Study

Yang, D., Tang, Y., Chan, V. K. Y., Fang, Q., Chan, S. S. M., Luo, H., Wong, I. C. K., Ou, H. T., Chan, E. W. Y., Bishai, D. M., Chen, Y., Knapp, M., Jit, M., Craig, D., & Li, X. (n.d.).

Publication year

2025

Journal title

Journal of medical Internet research

Volume

27

Issue

1

10.2196/67156

Abstract

Abstract

Background: Accurate prediction of population-wide depression incidence is vital for effective public mental health management. However, this incidence is often influenced by socioeconomic factors, such as abrupt events or changes, including pandemics, economic crises, and social unrest, creating complex structural break scenarios in the time-series data. These structural breaks can affect the performance of forecasting methods in various ways. Therefore, understanding and comparing different models across these scenarios is essential. Objective: This study aimed to develop depression incidence forecasting models and compare the performance of autoregressive integrated moving average (ARIMA) and vector-ARIMA (VARIMA) and temporal fusion transformers (TFT) under different structural break scenarios. Methods: We developed population-wide depression incidence forecasting models and compared the performance of ARIMA and VARIMA-based methods to TFT-based methods. Using monthly depression incidence from 2002 to 2022 in Hong Kong, we applied sliding windows to segment the whole time series into 72 ten-year subsamples. The forecasting models were trained, validated, and tested on each subsample. Within each 10-year subset, the first 7 years were used for training, with the eighth year for setting hold-out validation, and the ninth and tenth years for testing. The accuracy of the testing set within each 10-year subsample was measured by symmetric mean absolute percentage error (SMAPE). Results: We found that in subsamples without significant slope or trend change (structural break), multivariate TFT significantly outperformed univariate TFT, vector-ARIMA (VARIMA), and ARIMA, with an average SMAPE of 11.6% compared to 13.2% (P = .01) for univariate TFT, 16.4% (P = .002) for VARIMA, and 14.8% (P = .003) for ARIMA. Adjusting for the unemployment rate improved TFT performance more effectively than VARIMA. When fluctuating outbreaks happened, TFT was more robust to sharp interruptions, whereas VARIMA and ARIMA performed better when incidence surged and remained high. Conclusions: This study provides a comparative evaluation of TFT and ARIMA and VARIMA models for forecasting depression incidence under various structural break scenarios, offering insights into predicting disease burden during both stable and unstable periods. The findings support a decision-making framework for model selection based on the nature of disruptions and data characteristics. For public health policymaking, the results suggest that TFT may be a more suitable tool for disease burden forecasting during periods of stable burden level or when sudden temporary interruption, such as pandemics or socioeconomic variation, impacts disease occurrence.

Social contact patterns and their impact on the transmission of respiratory pathogens in rural China

Liang, Y., You, Q., Wang, Q., Yang, X., Zhong, G., Dong, K., Zhao, Z., Liu, N., Yan, X., Lu, W., Peng, C., Zhou, J., Lin, J., Litvinova, M., Jit, M., Ajelli, M., Yu, H., & Zhang, J. (n.d.).

Publication year

2025

Journal title

Infectious Disease Modelling

Volume

10

Issue

2

Page(s)

439-452

10.1016/j.idm.2024.12.006

Abstract

Abstract

Introduction: Social contact patterns significantly influence the transmission dynamics of respiratory pathogens. Previous surveys have quantified human social contact patterns, yielding heterogeneous results across different locations. However, significant gaps remain in understanding social contact patterns in rural areas of China. Methods: We conducted a pioneering study to quantify social contact patterns in Anhua County, Hunan Province, China, from June to October 2021, when there were minimal coronavirus disease-related restrictions in the area. Additionally, we simulated the epidemics under different assumptions regarding the relative transmission risks of various contact types (e.g., indoor versus outdoor, and physical versus non-physical). Results: Participants reported an average of 12.0 contacts per day (95% confidence interval: 11.3–12.6), with a significantly higher number of indoor contacts compared to outdoor contacts. The number of contacts was associated with various socio-demographic characteristics, including age, education level, income, household size, and travel patterns. Contact patterns were assortative by age and varied based on the type of contact (e.g., physical versus non-physical). The reproduction number, daily incidence, and infection attack rate of simulated epidemics were remarkably stable. Discussion: We found many intergenerational households and contacts that pose challenges in preventing and controlling infections among the elderly in rural China. Our study also underscores the importance of integrating various types of contact pattern data into epidemiological models and provides guidance to public health authorities and other major stakeholders in preparing and responding to infectious disease threats in rural China.

The global economic burden of antibiotic-resistant infections and the potential impact of bacterial vaccines: a modelling study

Naylor, N. R., Hasso-Agopsowicz, M., Kim, C., Ma, Y., Frost, I., Abbas, K., Aguilar, G., Fuller, N., Robotham, J. V., & Jit, M. (n.d.).

Publication year

2025

Journal title

BMJ Global Health

Volume

10

Issue

6

10.1136/bmjgh-2024-016249

Abstract

Abstract

Introduction Antibiotic resistance (ABR) may increase hospital costs, utility loss and mortality risk per patient. Understanding these losses at national, regional and global scales is necessary for efficiently tackling ABR. Our aim is to estimate the global economic burden of antibiotic-resistant infections and the potential for bacterial vaccines to mitigate this burden. Methods We take healthcare system and labour productivity perspectives. Hospital cost-per-case and length-of-stay estimates were calculated through meta-analyses and reviewing published systematic reviews. Unit labour productivity losses were estimated through a human capital approach. Modelled estimates were used where secondary data were missing. Death and incidence data were combined with unit cost data to estimate the economic burden associated with ABR in 2019, and the potential costs averted (in 2019 US$) based on uptake scenarios of vaccines that currently exist or are likely to be developed. Results Multidrug-resistant tuberculosis had the highest mean hospital cost attributable to ABR per patient, the range was US$3000 in lower-income settings to US$41 000 in high-income settings, with carbapenem-resistant infections associated with a high cost-per-case of US$3000–US$7000 depending on syndrome. ABR was associated with a median value of US$693 billion (IQR: US$627 bn–US$768 bn) in hospital costs globally, with US$207 bn (IQR: US$186 bn–US$229 bn) potentially avertable by vaccines. Productivity losses were quantified at almost US$194 billion, with US$76 bn avertable by vaccines. Conclusions The economic burden of ABR is associated with high levels of hospital bed-days occupied, hospital spending and labour productivity losses globally and should, therefore, remain high on national and international policy agendas. Vaccines against Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae would avert a substantial portion of the economic burden associated with ABR. More robust evidence, particularly in low-income countries, on the hospital costs, associated with and attributable to ABR, is needed.

The potential global health impact and cost-effectiveness of next-generation influenza vaccines: A modelling analysis

Goodfellow, L., Procter, S. R., Koltai, M., Waterlow, N. R., Filipe, J. A., Wong, C. K., Van Leeuwen, E., Eggo, R. M., & Jit, M. (n.d.).

Publication year

2025

Journal title

PLoS Medicine

Volume

22

Issue

6

10.1371/journal.pmed.1004655

Abstract

Abstract

Background Next-generation influenza vaccines (NGIVs) are in development and have the potential to achieve substantial reductions in influenza burden, with resulting widespread health and economic benefits. The prices at which their market can be sustained and which vaccination strategies may maximise health impact and cost-effectiveness, particularly in low- and middle-income countries, are unknown, yet such an understanding could provide a valuable tool for vaccine development and investment decision-making at a national and global level. To address this evidence gap, we projected the health and economic impact of NGIVs in 186 countries and territories. Methods and findings We inferred current influenza transmission parameters from World Health Organization (WHO) FluNet data in regions defined by their seasonal influenza timing and positivity, and projected 30 years of influenza epidemics, accounting for demographic changes. We considered vaccines including current seasonal vaccines, vaccines with increased efficacy, duration, and breadth of protection, and universal vaccines, defined in line with WHO Preferred Product Characteristics. We estimated cost-effectiveness of different vaccination scenarios using novel estimates of key health outcomes and costs. NGIVs have the potential to substantially reduce influenza burden: compared to no vaccination, vaccinating 50% of children aged under 18 annually prevented 1.3 (95% uncertainty range (UR): 1.2-1.5) billion infections using current vaccines, 2.6 (95% UR: 2.4-2.9) billion infections using vaccines with improved efficacy or breadth, and 3.0 (95% UR: 2.7-3.3) billion infections using universal vaccines. In many countries, NGIVs were cost-effective at higher prices than typically paid for existing seasonal vaccines. However, tiered prices may be necessary for improved vaccines to be cost-effective in lower income countries. This study is limited by the availability of accurate data on influenza incidence and influenzaassociated health outcomes and costs. Furthermore, the model involves simplifying assumptions around vaccination coverage and administration, and does not account for societal costs or budget impact of NGIVs. How NGIVs will compare to the vaccine types considered in this model when developed is unknown. We conducted sensitivity analyses to investigate key model parameters. Conclusions This study highlights the considerable potential health and economic benefits of NGIVs, but also the variation in cost-effectiveness between high-income and low- and middle-income countries. This work provides a framework for long-term global cost-effectiveness evaluations, and the findings can inform a pathway to developing NGIVs and rolling them out globally.

Vaccination strategies against wild poliomyelitis in polio-free settings: Outbreak risk modelling study and cost-effectiveness analysis

Auzenbergs, M., Abbas, K., Peak, C. M., Voorman, A., Jit, M., & O’Reilly, K. M. (n.d.).

Publication year

2025

Journal title

BMJ Global Health

Volume

10

Issue

3

10.1136/bmjgh-2024-016013

Abstract

Abstract

The 2021 importation of wild poliovirus serotype 1 (WPV1) into Malawi with subsequent international spread represented the first WPV1 cases in Africa since 2016. Preventing importations and spread of WPV1 is critical and dependent on population immunity provided through routine immunisation (RI) and supplementary immunisation activities (SIAs). We aim to estimate outbreak risk and costs, given the importation of WPV1 for non-endemic countries in the WHO Africa region. We developed a stochastic mathematical model of polio transmission dynamics to evaluate the probability of an outbreak, expected number of poliomyelitis cases, costs and incremental cost-effectiveness ratios under different vaccination strategies. Across variable RI coverage, we explore three key strategies: RI+outbreak SIAs (oSIAs), RI+oSIAs+annual preventative SIAs (pSIAs) and RI+oSIAs+biennial pSIAs. Results are presented in 2023 USD over a 5year-time horizon from the Global Polio Eradication Initiative (GPEI) and health system perspectives. The annual pSIA strategy has the greatest probability of no outbreaks in comparison to other strategies: under our model assumptions, annual pSIAs result in an 80% probability of no outbreaks when RI coverage is ≥50%. The biennial pSIA strategy requires RI coverage ≥65% to achieve an equivalent risk of no outbreaks. The strategy with no pSIAs requires ≥75% RI coverage to achieve an equivalent risk of no outbreaks. For the health system, when RI coverage is between 35% and 60%, both pSIA strategies are cost-saving. For the GPEI, below 65% RI pSIA strategies are cost-effective, but the biennial pSIA strategy incurs higher costs in comparison to annual pSIAs due to more oSIAs required to stop outbreaks. Prioritisation of pSIAs must balance outbreak risk against implementation costs, ideally favouring the smallest manageable outbreak risk compatible with elimination. We infer that there are few short-Term risks due to population immunity from RI, but without pSIAs, long-Term risks accumulate and can result in outbreaks with the potential for international spread.

A health technology assessment of COVID-19 vaccination for Nigerian decision-makers: Identifying stakeholders and pathways to support evidence uptake

Uzochukwu, B. S., Okeke, C., Shuaib, F., Torres-Rueda, S., Vassall, A., Jit, M., Nonvignon, J., Uzochukwu, A. C., & Ruiz, F. (n.d.).

Publication year

2024

Journal title

Health Research Policy and Systems

Volume

22

Issue

1

10.1186/s12961-024-01158-y

Abstract

Abstract

Background: Nigeria commenced rollout of vaccination for coronavirus disease 2019 (COVID-19) in March 2021 as part of the national public health response to the pandemic. Findings from appropriately contextualized cost–effectiveness analyses (CEA) as part of a wider process involving health technology assessment (HTA) approaches have been important in informing decision-making in this area. In this paper we outline the processes that were followed to identify COVID-19 vaccine stakeholders involved in the selection, approval, funding, procurement and rollout of vaccines in Nigeria, and describe the process routes we identified to support uptake of HTA-related information for evidence-informed policy in Nigeria. Methods: Our approach to engaging with policy-makers and other stakeholders as part of an HTA of COVID vaccination in Nigeria consisted of three steps, namely: (i) informal discussions with key stakeholders; (ii) stakeholder mapping, analysis and engagement; and (iii) communication and dissemination strategies for the HTA-relevant evidence produced. The analysis of the stakeholder mapping uses the power/interest grid framework. Results: The informal discussion with key stakeholders generated six initial policy questions. Further discussions with policy-makers yielded three suitable policy questions for analysis: which COVID-19 vaccines should be bought; what is the optimal mode of delivery of these vaccines; and what are the cost and cost–effectiveness of vaccinating people highlighted in Nigeria’s phase 2 vaccine rollout prioritized by the government, especially the inclusion of those aged between 18 and 49 years. The stakeholder mapping exercise highlighted the range of organizations and groups within Nigeria that could use the information from this HTA to guide decision-making. These stakeholders included both public/government, private and international organizations The dissemination plan developed included disseminating the full HTA results to key stakeholders; production of policy briefs; and presentation at different national and international conferences and peer-reviewed publications. Conclusions: HTA processes that involve stakeholder engagement will help ensure important policy questions are taken into account when designing any HTA including any underpinning evidence generation. Further guidance about stakeholder engagement throughout HTA is required, especially for those with low interest in vaccine procurement and use.

A Scoping Review and Taxonomy of Epidemiological-Macroeconomic Models of COVID-19

Bonnet, G., Pearson, C. A., Torres-Rueda, S., Ruiz, F., Lines, J., Jit, M., Vassall, A., & Sweeney, S. (n.d.).

Publication year

2024

Journal title

Value in Health

Volume

27

Issue

1

Page(s)

104-116

10.1016/j.jval.2023.10.008

Abstract

Abstract

Objectives: The COVID-19 pandemic placed significant strain on many health systems and economies. Mitigation policies decreased health impacts but had major macroeconomic impact. This article reviews models combining epidemiological and macroeconomic projections to enable policy makers to consider both macroeconomic and health objectives. Methods: A scoping review of epidemiological-macroeconomic models of COVID-19 was conducted, covering preprints, working articles, and journal publications. We assessed model methodologies, scope, and application to empirical data. Results: We found 80 articles modeling both the epidemiological and macroeconomic outcomes of COVID-19. Model scope is often limited to the impact of lockdown on health and total gross domestic product or aggregate consumption and to high-income countries. Just 14% of models assess disparities or poverty. Most models fall under 4 categories: compartmental-utility-maximization models, epidemiological models with stylized macroeconomic projections, epidemiological models linked to computable general equilibrium or input-output models, and epidemiological-economic agent-based models. We propose a taxonomy comparing these approaches to guide future model development. Conclusions: The epidemiological-macroeconomic models of COVID-19 identified have varying complexity and meet different modeling needs. Priorities for future modeling include increasing developing country applications, assessing disparities and poverty, and estimating of long-run impacts. This may require better integration between epidemiologists and economists.

An Application of an Initial Full Value of Vaccine Assessment Methodology to Measles-Rubella MAPs for Use in Low- and Middle-Income Countries

Ko, M., Frivold, C., Mvundura, M., Soble, A., Gregory, C., Christiansen, H., Hasso-Agopsowicz, M., Fu, H., Jit, M., Hsu, S., Mistilis, J. J., Scarna, T., Earle, K., Menozzi-Arnaud, M., Giersing, B., Jarrahian, C., Yakubu, A., Malvolti, S., & Amorij, J. P. (n.d.).

Publication year

2024

Journal title

Vaccines

Volume

12

Issue

9

10.3390/vaccines12091075

Abstract

Abstract

Measles and rubella micro-array patches (MR-MAPs) are a promising innovation to address limitations of the current needle and syringe (N&S) presentation due to their single-dose presentation, ease of use, and improved thermostability. To direct and accelerate further research and interventions, an initial full value vaccine assessment (iFVVA) was initiated prior to MR-MAPs entering phase I trials to quantify their value and identify key data gaps and challenges. The iFVVA utilized a mixed-methods approach with rapid assessment of literature, stakeholder interviews and surveys, and quantitative data analyses to (i) assess global need for improved MR vaccines and how MR-MAPs could address MR problem statements; (ii) estimate costs and benefits of MR-MAPs; (iii) identify the best pathway from development to delivery; and (iv) identify outstanding areas of need where stakeholder intervention can be helpful. These analyses found that if MR-MAPs are broadly deployed, they can potentially reach an additional 80 million children compared to the N&S presentation between 2030–2040. MR-MAPs can avert up to 37 million measles cases, 400,000 measles deaths, and 26 million disability-adjusted life years (DALYs). MR-MAPs with the most optimal product characteristics of low price, controlled temperature chain (CTC) properties, and small cold chain volumes were shown to be cost saving for routine immunization (RI) in low- and middle-income countries (LMICs) compared to N&S. Uncertainties about price and future vaccine coverage impact the potential cost-effectiveness of introducing MR-MAPs in LMICs, indicating that it could be cost-effective in 16–81% of LMICs. Furthermore, this iFVVA highlighted the importance of upfront donor investment in manufacturing set-up and clinical studies and the critical influence of an appropriate price to ensure country and manufacturer financial sustainability. To ensure that MR-MAPs achieve the greatest public health benefit, MAP developers, vaccine manufacturers, donors, financiers, and policy- and decision-makers will need close collaboration and open communications.

An overview of the perspectives used in health economic evaluations

Sittimart, M., Rattanavipapong, W., Mirelman, A. J., Hung, T. M., Dabak, S., Downey, L. E., Jit, M., Teerawattananon, Y., & Turner, H. C. (n.d.).

Publication year

2024

Journal title

Cost Effectiveness and Resource Allocation

Volume

22

Issue

1

10.1186/s12962-024-00552-1

Abstract

Abstract

The term ‘perspective’ in the context of economic evaluations and costing studies in healthcare refers to the viewpoint that an analyst has adopted to define the types of costs and outcomes to consider in their studies. However, there are currently notable variations in terms of methodological recommendations, definitions, and applications of different perspectives, depending on the objective or intended user of the study. This can make it a complex area for stakeholders when interpreting these studies. Consequently, there is a need for a comprehensive overview regarding the different types of perspectives employed in such analyses, along with the corresponding implications of their use. This is particularly important, in the context of low-and-middle-income countries (LMICs), where practical guidelines may be less well-established and infrastructure for conducting economic evaluations may be more limited. This article addresses this gap by summarising the main types of perspectives commonly found in the literature to a broad audience (namely the patient, payer, health care providers, healthcare sector, health system, and societal perspectives), providing their most established definitions and outlining the corresponding implications of their uses in health economic studies, with examples particularly from LMIC settings. We then discuss important considerations when selecting the perspective and present key arguments to consider when deciding whether the societal perspective should be used. We conclude that there is no one-size-fits-all answer to what perspective should be used and the perspective chosen will be influenced by the context, policymakers'/stakeholders’ viewpoints, resource/data availability, and intended use of the analysis. Moving forward, considering the ongoing issues regarding the variation in terminology and practice in this area, we urge that more standardised definitions of the different perspectives and the boundaries between them are further developed to support future studies and guidelines, as well as to improve the interpretation and comparison of health economic evidence.

Between now and later: a mixed methods study of HPV vaccination delay among Chinese caregivers in urban Chengdu, China

Yim, V. W. C., Wang, Q., Li, Y., Qin, C., Tang, W., Tang, S., Jit, M., Smith, J. S., Larson, H. J., Tucker, J. D., Li, J., Lin, L., & Wu, D. (n.d.).

Publication year

2024

Journal title

BMC public health

Volume

24

Issue

1

10.1186/s12889-024-17697-6

Abstract

Abstract

Background: Adolescent girls in China have a low HPV vaccination rate. Although vaccination is recommended by the Chinese health authorities, the cost is not covered by the national immunisation programme. Vaccination delay, among other reasons such as supply shortage and poor affordability, may contribute to low uptake. This sequential mixed methods study aimed to identify potential factors of delayed HPV vaccination among Chinese adolescent girls. Methods: Quantitative data about the attitudes and perceptions of HPV vaccination were collected from 100 caregivers of 14–18-year-old girls using an online survey in Chengdu, China. The survey data informed a subsequent qualitative study using four focus group discussions. We conducted a descriptive analysis of the survey data and a thematic analysis of the qualitative data. The findings were interpreted using a health behaviour model adapted from the Health Belief Model and the Andersen’s Behavioural Model for Health Services Use. Results: A total of 100 caregivers – 85 were mothers and 15 were fathers – participated in the survey; 21 caregivers joined focus group discussions. When asked about their intended course of action if the 9vHPV vaccine was out-of-stock, 74% chose to delay until the 9vHPV vaccine is available while 26% would consider 2vHPV or 4vHPV vaccines or seek alternative ways to procure the vaccine. Qualitative results confirmed that caregivers preferred delaying HPV vaccination for adolescent girls. The intent to delay was influenced by systemic barriers such as supply shortage and individual-level factors such as a preference for the 9vHPV vaccine, safety concerns, inadequate health communication, and the belief that adolescents were unlikely to be sexually active. Conclusion: In urban areas, Chinese caregivers’ intent to delay vaccination in favour of 9vHPV vaccine over receiving the more accessible options was influenced by a mix of individual and contextual factors. Focussed health communication strategies are needed to accelerate HPV vaccination among adolescents.

Clinical coding of long COVID in primary care 2020–2023 in a cohort of 19 million adults: an OpenSAFELY analysis

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Publication year

2024

Journal title

EClinicalMedicine

Volume

72

10.1016/j.eclinm.2024.102638

Abstract

Abstract

Background: Long COVID is the patient-coined term for the persistent symptoms of COVID-19 illness for weeks, months or years following the acute infection. There is a large burden of long COVID globally from self-reported data, but the epidemiology, causes and treatments remain poorly understood. Primary care is used to help identify and treat patients with long COVID and therefore Electronic Health Records (EHRs) of past COVID-19 patients could be used to help fill these knowledge gaps. We aimed to describe the incidence and differences in demographic and clinical characteristics in recorded long COVID in primary care records in England. Methods: With the approval of NHS England we used routine clinical data from over 19 million adults in England linked to SARS-COV-2 test result, hospitalisation and vaccination data to describe trends in the recording of 16 clinical codes related to long COVID between November 2020 and January 2023. Using OpenSAFELY, we calculated rates per 100,000 person-years and plotted how these changed over time. We compared crude and adjusted (for age, sex, 9 NHS regions of England, and the dominant variant circulating) rates of recorded long COVID in patient records between different key demographic and vaccination characteristics using negative binomial models. Findings: We identified a total of 55,465 people recorded to have long COVID over the study period, which included 20,025 diagnoses codes and 35,440 codes for further assessment. The incidence of new long COVID records increased steadily over 2021, and declined over 2022. The overall rate per 100,000 person-years was 177.5 cases in women (95% CI: 175.5–179) and 100.5 in men (99.5–102). The majority of those with a long COVID record did not have a recorded positive SARS-COV-2 test 12 or more weeks before the long COVID record. Interpretation: In this descriptive study, EHR recorded long COVID was very low between 2020 and 2023, and incident records of long COVID declined over 2022. Using EHR diagnostic or referral codes unfortunately has major limitations in identifying and ascertaining true cases and timing of long COVID. Funding: This research was supported by the National Institute for Health and Care Research (NIHR) (OpenPROMPT: COV-LT2-0073).

Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization

Shattock, A. J., Johnson, H. C., Sim, S. Y., Carter, A., Lambach, P., Hutubessy, R. C., Thompson, K. M., Badizadegan, K., Lambert, B., Ferrari, M. J., Jit, M., Fu, H., Silal, S. P., Hounsell, R. A., White, R. G., Mosser, J. F., Gaythorpe, K. A., Trotter, C. L., Lindstrand, A., … Bar-Zeev, N. (n.d.).

Publication year

2024

Journal title

The Lancet

Volume

403

Issue

10441

Page(s)

2307-2316

10.1016/S0140-6736(24)00850-X

Abstract

Abstract

Background: WHO, as requested by its member states, launched the Expanded Programme on Immunization (EPI) in 1974 to make life-saving vaccines available to all globally. To mark the 50-year anniversary of EPI, we sought to quantify the public health impact of vaccination globally since the programme's inception. Methods: In this modelling study, we used a suite of mathematical and statistical models to estimate the global and regional public health impact of 50 years of vaccination against 14 pathogens in EPI. For the modelled pathogens, we considered coverage of all routine and supplementary vaccines delivered since 1974 and estimated the mortality and morbidity averted for each age cohort relative to a hypothetical scenario of no historical vaccination. We then used these modelled outcomes to estimate the contribution of vaccination to globally declining infant and child mortality rates over this period. Findings: Since 1974, vaccination has averted 154 million deaths, including 146 million among children younger than 5 years of whom 101 million were infants younger than 1 year. For every death averted, 66 years of full health were gained on average, translating to 10·2 billion years of full health gained. We estimate that vaccination has accounted for 40% of the observed decline in global infant mortality, 52% in the African region. In 2024, a child younger than 10 years is 40% more likely to survive to their next birthday relative to a hypothetical scenario of no historical vaccination. Increased survival probability is observed even well into late adulthood. Interpretation: Since 1974 substantial gains in childhood survival have occurred in every global region. We estimate that EPI has provided the single greatest contribution to improved infant survival over the past 50 years. In the context of strengthening primary health care, our results show that equitable universal access to immunisation remains crucial to sustain health gains and continue to save future lives from preventable infectious mortality. Funding: WHO.

Cost-effectiveness of COVID rapid diagnostic tests for patients with severe/critical illness in low- and middle-income countries: A modeling study

Bonnet, G., Bimba, J., Chavula, C., Chifamba, H. N., Divala, T. H., Lescano, A. G., Majam, M., Mbo, D., Suwantika, A. A., Tovar, M. A., Yadav, P., Ekwunife, O., Mangenah, C., Ngwira, L. G., Corbett, E. L., Jit, M., & Vassall, A. (n.d.).

Publication year

2024

Journal title

PLoS Medicine

Volume

21

Issue

7

10.1371/journal.pmed.1004429

COVID-19-related health utility values and changes in COVID-19 patients and the general population: a scoping review

Mao, Z., Li, X., Jit, M., & Beutels, P. (n.d.).

Publication year

2024

Journal title

Quality of Life Research

Volume

33

Issue

6

Page(s)

1443-1454

10.1007/s11136-023-03584-x

Abstract

Abstract

Purpose: To summarise the diverse literature reporting the impact of COVID-19 on health utility in COVID-19 patients as well as in general populations being affected by COVID-19 control policies. Methods: A literature search up to April 2023 was conducted to identify papers reporting health utility in COVID-19 patients or in COVID-19-affected general populations. We present a narrative synthesis of the health utility values/losses of the retained studies to show the mean health utility values/losses with 95% confidence intervals. Mean utility values/losses for categories defined by medical attendance and data collection time were calculated using random-effects models. Results: In total, 98 studies—68 studies on COVID-19 patients and 30 studies on general populations—were retained for detailed review. Mean (95% CI) health utility values were 0.83 (0.81, 0.86), 0.78 (0.73, 0.83), 0.82 (0.78, 0.86) and 0.71 (0.65, 0.78) for general populations, non-hospitalised, hospitalised and ICU patients, respectively, irrespective of the data collection time. Mean utility losses in patients and general populations ranged from 0.03 to 0.34 and from 0.02 to 0.18, respectively. Conclusions: This scoping review provides a summary of the health utility impact of COVID-19 and COVID-19 control policies. COVID-19-affected populations were reported to have poor health utility, while a high degree of heterogeneity was observed across studies. Population- and/or country-specific health utility is recommended for use in future economic evaluation on COVID-19-related interventions.

Effectiveness and efficiency of immunisation strategies to prevent RSV among infants and older adults in Germany: a modelling study

Krauer, F., Guenther, F., Treskova-Schwarzbach, M., Schoenfeld, V., Koltai, M., Jit, M., Hodgson, D., Schneider, U., Wichmann, O., Harder, T., Sandmann, F. G., & Flasche, S. (n.d.).

Publication year

2024

Journal title

BMC Medicine

Volume

22

Issue

1

10.1186/s12916-024-03687-3

Abstract

Abstract

Background: Recently, several novel RSV immunisation products that protect infants and older adults against RSV disease have been licensed in Europe. We estimated the effectiveness and efficiency of introducing these RSV immunisation strategies in Germany. Methods: We used a Bayesian framework to fit a deterministic age-structured dynamic transmission model of RSV to sentinel surveillance and RSV-specific hospitalisation data in Germany from 2015 to 2019. The calibrated model was used to evaluate different RSV intervention strategies over 5 years: long-acting, single-dose monoclonal antibodies (mAbs) in high-risk infants aged 1–5 months; long-acting mAbs in all infants aged 1–5 months; seasonal vaccination of pregnant women and one-time seasonal vaccination of older adults (75 + /65 + /55 + years). We performed sensitivity analysis on vaccine uptake, seasonal vs. year-round maternal vaccination, and the effect of under-ascertainment for older adults. Results: The model was able to match the various RSV datasets. Replacing the current short-acting mAB for high-risk infants with long-acting mAbs prevented 1.1% of RSV-specific hospitalisations in infants per year at the same uptake. Expanding the long-acting mAB programme to all infants prevented 39.3% of infant hospitalisations per year. Maternal vaccination required a larger number to be immunised to prevent one additional hospitalisation than a long-acting mAB for the same uptake. Vaccination of adults older than 75 years at an uptake of 40% in addition to Nirsevimab in all infants prevented an additional 4.5% of all RSV hospitalisations over 5 years, with substantial uncertainty in the correction for under-ascertainment of the RSV burden. Conclusions: Immunisation has the potential to reduce the RSV disease burden in Germany.