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

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

for PROMISE investigators, A., Li, X., Willem, L., Johannesen, C. K., Urchueguía-Fornes, A., Lehtonen, T., Osei-Yeboah, R., Salo, H., Orrico-Sánchez, A., Díez-Domingo, J., Jit, M., Hendri, J., Begier, E., Kumar, V., Janimak, J., Kramer, R., Molero, E., Paget, J., Nohynek, H., … Bilcke, J. (n.d.).

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.

International Dimensions of Infectious Disease Control: Applications to Platform Responsibility

Jit, M., & Hofstetter, D. K. (n.d.). (B. C. and J. P. Trachtman, Ed.).

Publication year

2025

Page(s)

105-121

Abstract

Abstract

~

Pay-it-forward strategy reduced HPV vaccine delay and increased uptake among catch-up age girls: A randomized clinical trial

Li, J., Li, Y., Qi, 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

medRxiv : the preprint server for health sciences

Abstract

Abstract

Catch-up 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.

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., Fang, Q., Chan, S. S., Luo, H., Wong, I. C., Ou, H. T., Chan, E. W., 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.

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. T., Chan, E. W. Y., Bishai, D. M. 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

Page(s)

e67156

Abstract

Abstract

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.

Ranking the most efficient human papillomavirus vaccination strategies in low-income and lower-middle income countries: a mathematical modelling analysis

Bénard, É., Drolet, M., Gingras, G., Laprise, J.-F. F., Sabourin, A.-A. A., Bloem, P., Akaba, H., Brotherton, J., Jit, M., & Brisson, M. (n.d.).

Publication year

2025

Journal title

The Lancet. Global health

Volume

13

Issue

12

Page(s)

e2153-e2164

Abstract

Abstract

One-dose vaccination and increased vaccine supply provide the opportunity for low-income countries (LICs) and lower-middle-income countries (LMICs) to extend human papillomavirus (HPV) vaccination to populations other than girls aged 9-14 years targeted by routine vaccination. The aim of our study was to use mathematical modelling to identify and rank HPV vaccination strategies according to their efficiency at reducing cervical cancer in LICs and LMICs.

Regional cooperation on pandemic preparedness and vaccine equity from an economic, regulatory and legal perspective

Chan, M. X., Wouters, O. J., Chan, H. Y., Terblanche, P., Premsri, N., Kim, J. H., Lim, J. C., Tan-Koi, W. C., & Jit, M. (n.d.).

Publication year

2025

Journal title

Vaccine

Volume

53

10.1016/j.vaccine.2025.127107

Abstract

Abstract

The COVID-19 pandemic has underscored the need for a global agreement to strengthen international health regulations. However, progress towards such an agreement has been deferred to a future World Health Assembly and is likely to be further hampered by an increasingly uncertain global geopolitical context, a delay which we cannot afford. In the interim, urgent immediate action to intensify regional cooperation on pandemic preparedness and vaccine equity is needed. The three key aspects of intensified regional cooperation are: financial and economic sustainability, regulatory systems strengthening and legal frameworks that facilitate cooperation. While there is still momentum, the global community must act swiftly and cohesively, intensifying regional cooperation to strengthen governance on pandemic prevention, preparedness and response.

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 path to equitable respiratory syncytial virus prevention for infants: challenges and opportunities for global implementation

Shaaban, F. L., Groenendijk, R. W., Baral, R., Caballero, M. T., Crowe, J. E., Englund, J. A., Esteban, I., Hirve, S., Jit, M., Kalergis, A. M., Karron, R. A., Lukacs, N., Martinon-Torres, F., Mejias, A., Nair, H., Nisar, M. I. I., Nyiro, J. U., Pecenka, C., Sparrow, E., … Bont, L. J. (n.d.).

Publication year

2025

Journal title

The Lancet. Global health

Volume

13

Issue

12

Page(s)

e2165-e2174

Abstract

Abstract

The approval for a respiratory syncytial virus (RSV) maternal vaccination programme by Gavi, The Vaccine Alliance, marks substantial progress toward equitable access, with important work still to come. Several countries, most of which are high-income, have introduced RSV immunisation either using a vaccine containing the RSV fusion protein in its prefusion conformation, which is given to pregnant people in late pregnancy, or by using a long-acting monoclonal antibody (mAb) administered directly to infants. Post-implementation real-world effectiveness data show a major impact in reducing medically attended RSV-lower respiratory tract illness and hospitalisation using either strategy. Although RSV poses a substantial burden to infants and vulnerable children worldwide, 97% of associated mortality occurs in low-income and middle-income countries. However, few of these countries have authorised and introduced RSV preventive strategies. This Review outlines the challenges and opportunities for expanding access to RSV prevention for infants in resource-restricted settings guided by WHO's Immunization Agenda 2030 and the UN's Leave No One Behind framework for non-discriminatory sustainable development. We discuss burden, vaccine and mAb development, health economics and impact modelling, policy, implementation and programmatic considerations, surveillance, and awareness as key RSV domains. This Review summarises recent advances in research and highlights the urgent steps needed to ensure equitable access to RSV prevention for all infants worldwide.

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 June

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.

Valuing combination vaccines: an incomplete picture and a pathway to a broader view

Debellut, F., Jit, M., Portnoy, A., Mvundura, M., Giersing, B., Hasso-Agopsowicz, M., Hausdorff, W. P., & Pecenka, C. (n.d.).

Publication year

2025

Journal title

Vaccine

Volume

63

Page(s)

127675

Abstract

Abstract

~

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

Uzochukwu, B. S. C., 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

Page(s)

73

Abstract

Abstract

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.

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., 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

Page(s)

102638

Abstract

Abstract

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.

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

The OpenSAFELY Collaborative, A., Henderson, A. D., Butler-Cole, B. F., Tazare, J., Tomlinson, L. A., Marks, M., Jit, M., Briggs, A., Lin, L. Y., Carlile, O., Bates, C., Parry, J., Bacon, S. C., Dillingham, I., Dennison, W. A., Costello, R. E., Wei, Y., Walker, A. J., Hulme, W., … Higgins, R. (n.d.).

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.

Correction to "Protecting infants against RSV disease: an impact and cost-effectiveness comparison of long-acting monoclonal antibodies and maternal vaccination" [The Lancet Regional Health - Europe 38 (2024) 100829]

Hodgson, D., Wilkins, N., van Leeuwen, E., Watson, C. H., Crofts, J., Flasche, S., Jit, M., & Atkins, K. E. (n.d.).

Publication year

2024

Journal title

The Lancet regional health. Europe

Volume

45

Page(s)

101073

Abstract

Abstract

[This corrects the article DOI: 10.1016/j.lanepe.2023.100829.].

Correction to “Protecting infants against RSV disease : an impact and cost-effectiveness comparison of long-acting monoclonal antibodies and maternal vaccination” [The Lancet Regional Health – Europe 38 (2024) 100829] (The Lancet Regional Health - Europe (2024) 38, (S266677622300248X), (10.1016/j.lanepe.2023.100829))

Hodgson, D., Wilkins, N., van Leeuwen, E., Watson, C. H., Crofts, J., Flasche, S., Jit, M., & Atkins, K. E. (n.d.).

Publication year

2024

Journal title

The Lancet Regional Health - Europe

Volume

45

10.1016/j.lanepe.2024.101073

Abstract

Abstract

The authors have noticed an error in the Supplementary Material Table S1, in which the code erroneously calculated the average instead of the sum across the age groups, resulting in the Supplementary Table S1 displaying the mean number of cases rather than the total. This aggregated data was subsequently used to plot Supplementary Figure S2. The code has now been corrected to sum the outputs, as reflected in the revised Supplementary Table S1 and Supplementary Figure S2, which can be found below: Since this error is confined solely to the aggregated values presented in that Table and Figure, it does not affect any interpretations and conclusions in the article. If you have any further questions or comments, we will of course be happy to address them. The authors would like to apologise for any inconvenience caused.

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 July

10.1371/journal.pmed.1004429

Abstract

Abstract

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