Mark Jit
Mark Jit
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Chair and Professor of the Department of Global and Environmental Health
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Professional overview
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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.
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Education
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BSc, Mathematics, University College LondonPhD, Mathematics, University College LondonMPH, Public Health, King's College London
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Honors and awards
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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)
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Publications
Publications
Optimal human papillomavirus vaccination strategies in the context of vaccine supply constraints in 100 countries
AbstractPrem, K., Cernuschi, T., Malvolti, S., Brisson, M., & Jit, M. (n.d.).Publication year
2024Journal title
EClinicalMedicineVolume
74Page(s)
102735AbstractCountries are recommended to immunise adolescent girls routinely with one or two doses of human papillomavirus (HPV) vaccines to eliminate cervical cancer as a public health problem. With most existing vaccine doses absorbed by countries (mostly high-income) with existing HPV vaccination programmes, limited supply has been left for new country introductions until 2022; many of those, low- and middle-income countries with higher mortality. Several vaccination strategies were considered by the Strategic Advisory Group of Experts on Immunization to allow more countries to introduce vaccination despite constrained supplies.Overcoming challenges in the economic evaluation of interventions to optimise antibiotic use
Abstracton behalf of the STEPUP team, A., Roope, L. S., Morrell, L., Buchanan, J., Ledda, A., Adler, A. I., Jit, M., Walker, A. S., Pouwels, K. B., Robotham, J. V., Wordsworth, S., Zalevski, A., Yadav, S., Wright, C., Tonkin-Crine, S., Moore, M., McLeod, M., Majeed, A., Hopkins, S., … Anyanwu, P. E. (n.d.).Publication year
2024Journal title
Communications MedicineVolume
4Issue
1AbstractBacteria are becoming increasingly resistant to antibiotics, reducing our ability to treat infections and threatening to undermine modern health care. Optimising antibiotic use is a key element in tackling the problem. Traditional economic evaluation methods do not capture many of the benefits from improved antibiotic use and the potential impact on resistance. Not capturing these benefits is a major obstacle to optimising antibiotic use, as it fails to incentivise the development and use of interventions to optimise the use of antibiotics and preserve their effectiveness (stewardship interventions). Estimates of the benefits of improving antibiotic use involve considerable uncertainty as they depend on the evolution of resistance and associated health outcomes and costs. Here we discuss how economic evaluation methods might be adapted, in the face of such uncertainties. We propose a threshold-based approach that estimates the minimum resistance-related costs that would need to be averted by an intervention to make it cost-effective. If it is probable that without the intervention costs will exceed the threshold then the intervention should be deemed cost-effective.Overcoming challenges in the economic evaluation of interventions to optimise antibiotic use
Failed generating bibliography.AbstractPublication year
2024Journal title
Communications medicineVolume
4Issue
1Page(s)
101AbstractBacteria are becoming increasingly resistant to antibiotics, reducing our ability to treat infections and threatening to undermine modern health care. Optimising antibiotic use is a key element in tackling the problem. Traditional economic evaluation methods do not capture many of the benefits from improved antibiotic use and the potential impact on resistance. Not capturing these benefits is a major obstacle to optimising antibiotic use, as it fails to incentivise the development and use of interventions to optimise the use of antibiotics and preserve their effectiveness (stewardship interventions). Estimates of the benefits of improving antibiotic use involve considerable uncertainty as they depend on the evolution of resistance and associated health outcomes and costs. Here we discuss how economic evaluation methods might be adapted, in the face of such uncertainties. We propose a threshold-based approach that estimates the minimum resistance-related costs that would need to be averted by an intervention to make it cost-effective. If it is probable that without the intervention costs will exceed the threshold then the intervention should be deemed cost-effective.Population-level impact of switching to 1-dose human papillomavirus vaccination in high-income countries : examining uncertainties using mathematical modeling
AbstractBrisson, M., Laprise, J. F., Drolet, M., Chamberland, É., Bénard, É., Burger, E. A., Jit, M., Kim, J. J., Markowitz, L. E., Sauvageau, C., & Sy, S. (n.d.).Publication year
2024Journal title
Journal of the National Cancer Institute. MonographsVolume
2024Issue
67Page(s)
387-399AbstractBACKGROUND: A concern in high-income countries is that switching to 1-dose human papillomavirus (HPV) vaccination could cause a rebound in HPV infection and cervical cancer if 1-dose efficacy or duration were inferior to 2 doses. Using mathematical modeling and up-to-date trial-based data, we projected the population-level effectiveness of switching from 2-dose to 1-dose vaccination under different vaccine efficacy and duration assumptions in high-income countries. METHODS: We used HPV-ADVISE (Agent-based Dynamic model for VaccInation and Screening Evaluation), a transmission-dynamic model of HPV infection and cervical cancer, varying key model assumptions to identify those with the greatest impact on projections of HPV-16 and cervical cancer incidence over time: 1) 1-dose vaccine efficacy and vaccine duration, 2) mechanisms of vaccine efficacy and duration over time, 3) midadult (>30 years of age) sexual behavior, 4) progression to cervical cancer among midadults, and 5) vaccination coverage and programs. RESULTS: In high-income countries, 1-dose vaccination would cause no appreciable rebound in HPV-16 infection, except for a limited rebound under the most pessimistic assumptions of vaccine duration (average, 25 years), because 1) the switch would occur when HPV prevalence is low because of high 2-dose vaccination coverage and 2) individuals would be protected during their peak ages of sexual activity (Protecting infants against RSV disease : an impact and cost-effectiveness comparison of long-acting monoclonal antibodies and maternal vaccination
AbstractHodgson, D., Wilkins, N., van Leeuwen, E., Watson, C. H., Crofts, J., Flasche, S., Jit, M., & Atkins, K. E. (n.d.).Publication year
2024Journal title
The Lancet Regional Health - EuropeVolume
38AbstractBackground: Two new products for preventing Respiratory Syncytial Virus (RSV) in young children have been licensed: a single-dose long-acting monoclonal antibody (la-mAB) and a maternal vaccine (MV). To facilitate the selection of new RSV intervention programmes for large-scale implementation, this study provides an assessment to compare the costs of potential programmes with the health benefits accrued. Methods: Using an existing dynamic transmission model, we compared maternal vaccination to la-mAB therapy against RSV in England and Wales by calculating the impact and cost-effectiveness. We calibrated a statistical model to the efficacy trial data to accurately capture their immune waning and estimated the impact of seasonal and year-round programmes for la-mAB and MV programmes. Using these impact estimates, we identified the most cost-effective programme across pricing and delivery cost assumptions. Findings: For infants under six months old in England and Wales, a year-round MV programme with 60% coverage would avert 32% (95% CrI 22–41%) of RSV hospital admissions and a year-round la-mAB programme with 90% coverage would avert 57% (95% CrI 41–69%). The MV programme has additional health benefits for pregnant women, which account for 20% of the population-level health burden averted. A seasonal la-mAB programme could be cost-effective for up to £84 for purchasing and administration (CCPA) and a seasonal MV could be cost-effective for up to £80 CCPA. Interpretation: This modelling and cost-effectiveness analysis has shown that both the long-acting monoclonal antibodies and the maternal vaccine could substantially reduce the burden of RSV disease in the infant population. Our analysis has informed JCVI's recommendations for an RSV immunisation programme to protect newborns and infants. Funding: National Institute for Health Research.Protecting infants against RSV disease: an impact and cost-effectiveness comparison of long-acting monoclonal antibodies and maternal vaccination
AbstractHodgson, D., Wilkins, N., van Leeuwen, E., Watson, C. H., Crofts, J., Flasche, S., Jit, M., & Atkins, K. E. (n.d.).Publication year
2024Journal title
The Lancet regional health. EuropeVolume
38Page(s)
100829AbstractTwo new products for preventing Respiratory Syncytial Virus (RSV) in young children have been licensed: a single-dose long-acting monoclonal antibody (la-mAB) and a maternal vaccine (MV). To facilitate the selection of new RSV intervention programmes for large-scale implementation, this study provides an assessment to compare the costs of potential programmes with the health benefits accrued.Re-evaluating the impact and cost-effectiveness of pneumococcal conjugate vaccine introduction in 112 low-income and middle-income countries in children younger than 5 years : a modelling study
AbstractChen, C., Ang, G., Akksilp, K., Koh, J., Scott, J. A., Clark, A., & Jit, M. (n.d.).Publication year
2024Journal title
The Lancet Global HealthVolume
12Issue
9Page(s)
e1485-e1497AbstractBackground: Streptococcus pneumoniae has been estimated to cause 9·18 million cases of pneumococcal pneumonia, meningitis, and invasive non-pneumonia non-meningitis disease and 318 000 deaths among children younger than 5 years in 2015. We estimated the potential impact and cost-effectiveness of pneumococcal conjugate vaccine (PCV) introduction. Methods: We updated our existing pseudodynamic model to estimate the impact of 13-valent PCV (PCV13) in 112 low-income and middle-income countries by adapting our previously published pseudodynamic model with new country-specific evidence on vaccine coverage, burden, and post-introduction vaccine impact from WHO–UNICEF estimates of national immunisation coverage and a global burden study. Deaths, disability-adjusted life-years (DALYs), and cases averted were estimated for children younger than 5 years born between 2000 and 2030. We used specific PCV coverage in each country and a hypothetical scenario in which coverage increased to diphtheria–tetanus–pertussis (DTP) levels. We conducted probabilistic uncertainty analyses. Findings: Using specific vaccine coverage in countries, we estimated that PCV13 could prevent 697 000 (95% credibility interval 359 000–1 040 000) deaths, 46·0 (24·0–68·9) million DALYs, and 131 (89·0–172) million cases in 112 countries between 2000 and 2030. PCV was estimated to prevent 5·3% of pneumococcal deaths in children younger than 5 years during 2000–30. The incremental cost of vaccination would be I$851 (510–1530) per DALY averted. If PCV coverage were increased to DTP coverage in 2020, PCV13 could prevent an additional 146 000 (75 500–219 000) deaths. Interpretation: The inclusion of real-world evidence from lower-income settings revealed that delays in PCV roll-out globally and low PCV coverage have cost many lives. Countries with delays in vaccine introduction or low vaccine coverage have experienced many PCV-preventable deaths. These findings underscore the importance of rapidly scaling up PCV to achieve high coverage and maximise vaccine impact. Funding: Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.Spatiotemporal trends in COVID-19 vaccine sentiments on a social media platform and correlations with reported vaccine coverage
AbstractZhou, X., Zhang, X., Larson, H. J., de Figueiredo, A., Jit, M., Fodeh, S., Vermund, S. H., Zang, S., Lin, L., & Hou, Z. (n.d.).Publication year
2024Journal title
Bulletin of the World Health OrganizationVolume
102Issue
1Page(s)
32-45AbstractObjective To assess spatiotemporal trends in, and determinants of, the acceptance of coronavirus disease 2019 (COVID-19) vaccination globally, as expressed on the social media platform X (formerly Twitter). Methods We collected over 13 million posts on the platform regarding COVID-19 vaccination made between November 2020 and March 2022 in 90 languages. Multilingual deep learning XLM-RoBERTa models annotated all posts using an annotation framework after being fine-tuned on 8125 manually annotated, English-language posts. The annotation results were used to assess spatiotemporal trends in COVID-19 vaccine acceptance and confidence as expressed by platform users in 135 countries and territories. We identified associations between spatiotemporal trends in vaccine acceptance and country-level characteristics and public policies by using univariate and multivariate regression analysis. Findings A greater proportion of platform users in the World Health Organization’s South-East Asia, Eastern Mediterranean and Western Pacific Regions expressed vaccine acceptance than users in the rest of the world. Countries in which a greater proportion of platform users expressed vaccine acceptance had higher COVID-19 vaccine coverage rates. Trust in government was also associated with greater vaccine acceptance. Internationally, vaccine acceptance and confidence declined among platform users as: (i) vaccination eligibility was extended to adolescents; (ii) vaccine supplies became sufficient; (iii) nonpharmaceutical interventions were relaxed; and (iv) global reports on adverse events following vaccination appeared. Conclusion Social media listening could provide an effective and expeditious means of informing public health policies during pandemics, and could supplement existing public health surveillance approaches in addressing global health issues.The cost of care for children hospitalized with respiratory syncytial virus (RSV) associated lower respiratory infection in Kenya
AbstractNyiro, J. U., Nyawanda, B. O., Mutunga, M., Murunga, N., Nokes, D. J. J., Bigogo, G., Otieno, N. A., Lidechi, S., Mazoya, B., Jit, M., Cohen, C., Moyes, J., Pecenka, C., Baral, R., Onyango, C., Munywoki, P. K., & Vodicka, E. (n.d.).Publication year
2024Journal title
BMC public healthVolume
24Issue
1Page(s)
2410AbstractRespiratory syncytial virus (RSV) is one of the main causes of hospitalization for lower respiratory tract infection in children under five years of age globally. Maternal vaccines and monoclonal antibodies for RSV prevention among infants are approved for use in high income countries. However, data are limited on the economic burden of RSV disease from low- and middle-income countries (LMIC) to inform decision making on prioritization and introduction of such interventions. This study aimed to estimate household and health system costs associated with childhood RSV in Kenya.The cost of care for children hospitalized with respiratory syncytial virus (RSV) associated lower respiratory infection in Kenya
AbstractNyiro, J. U., Nyawanda, B. O., Mutunga, M., Murunga, N., Nokes, D. J., Bigogo, G., Otieno, N. A., Lidechi, S., Mazoya, B., Jit, M., Cohen, C., Moyes, J., Pecenka, C., Baral, R., Onyango, C., Munywoki, P. K., & Vodicka, E. (n.d.).Publication year
2024Journal title
BMC public healthVolume
24Issue
1AbstractBackground: Respiratory syncytial virus (RSV) is one of the main causes of hospitalization for lower respiratory tract infection in children under five years of age globally. Maternal vaccines and monoclonal antibodies for RSV prevention among infants are approved for use in high income countries. However, data are limited on the economic burden of RSV disease from low- and middle-income countries (LMIC) to inform decision making on prioritization and introduction of such interventions. This study aimed to estimate household and health system costs associated with childhood RSV in Kenya. Methods: A structured questionnaire was administered to caregivers of children aged < 5 years admitted to referral hospitals in Kilifi (coastal Kenya) and Siaya (western Kenya) with symptoms of acute lower respiratory tract infection (LRTI) during the 2019–2021 RSV seasons. These children had been enrolled in ongoing in-patient surveillance for respiratory viruses. Household expenditures on direct and indirect medical costs were collected 10 days prior to, during, and two weeks post hospitalization. Aggregated health system costs were acquired from the hospital administration and were included to calculate the cost per episode of hospitalized RSV illness. Results: We enrolled a total of 241 and 184 participants from Kilifi and Siaya hospitals, respectively. Out of these, 79 (32.9%) in Kilifi and 21(11.4%) in Siaya, tested positive for RSV infection. The total (health system and household) mean costs per episode of severe RSV illness was USD 329 (95% confidence interval (95% CI): 251–408) in Kilifi and USD 527 (95% CI: 405– 649) in Siaya. Household costs were USD 67 (95% CI: 54–80) and USD 172 (95% CI: 131– 214) in Kilifi and Siaya, respectively. Mean direct medical costs to the household during hospitalization were USD 11 (95% CI: 10–12) and USD 67 (95% CI: 51–83) among Kilifi and Siaya participants, respectively. Observed costs were lower in Kilifi due to differences in healthcare administration. Conclusions: RSV-associated disease among young children leads to a substantial economic burden to both families and the health system in Kenya. This burden may differ between Counties in Kenya and similar multi-site studies are advised to support cost-effectiveness analyses.The Full Value of Vaccine Assessments Concept—Current Opportunities and Recommendations
AbstractWhite, R. G., Menzies, N. A., Portnoy, A., Clark, R. A., Toscano, C. M., Weller, C., Tufet Bayona, M., Silal, S. P., Karron, R. A., Lee, J. S., Excler, J. L., Lauer, J. A., Giersing, B., Lambach, P., Hutubessy, R., & Jit, M. (n.d.).Publication year
2024Journal title
VaccinesVolume
12Issue
4AbstractFor vaccine development and adoption decisions, the ‘Full Value of Vaccine Assessment’ (FVVA) framework has been proposed by the WHO to expand the range of evidence available to support the prioritization of candidate vaccines for investment and eventual uptake by low- and middle-income countries. Recent applications of the FVVA framework have already shown benefits. Building on the success of these applications, we see important new opportunities to maximize the future utility of FVVAs to country and global stakeholders and provide a proof-of-concept for analyses in other areas of disease control and prevention. These opportunities include the following: (1) FVVA producers should aim to create evidence that explicitly meets the needs of multiple key FVVA consumers, (2) the WHO and other key stakeholders should develop standardized methodologies for FVVAs, as well as guidance for how different stakeholders can explicitly reflect their values within the FVVA framework, and (3) the WHO should convene experts to further develop and prioritize the research agenda for outcomes and benefits relevant to the FVVA and elucidate methodological approaches and opportunities for standardization not only for less well-established benefits, but also for any relevant research gaps. We encourage FVVA stakeholders to engage with these opportunities.The Impact of Public Health and Social Measures (PHSMs) on SARS-CoV-2 Transmission in the WHO European Region (2020–2022)
AbstractLiu, Y., Diamond, C., Abbott, S., Wong, K., Schmidt, T., Edmunds, W., Pebody, R., & Jit, M. (n.d.).Publication year
2024Journal title
Influenza and other Respiratory VirusesVolume
18Issue
12AbstractBackground: Between 2020 and 2022, countries used a range of different public health and social measures (PHSMs) to reduce the transmission of SARS-CoV-2. The impact of these PHSMs varied as the pandemic progressed, variants of concern (VOCs) emerged, vaccines rolled out and acceptance/uptake rates evolved. In this study, we assessed the impact of PHSMs in the World Health Organization (WHO) European Region during VOC phases. Methods: We relied on time series data on genome sequencing, PHSMs, health outcomes and physical contacts. Panel regression models were used to assess the association between PHSMs and SARS-CoV-2 transmission (approximated using time-varying reproduction numbers). The interpretation of these regression models was assisted by hierarchical clustering, which was used to detect the temporal co-occurrence of PHSMs. Generalised linear models were used to check if PHSMs are associated with physical contacts. Results: We identified four phases based on the dominating VOC in the WHO European Region: wild type (before early 2021), Alpha (early to mid-2021), Delta (mid-to-late 2021) and Omicron (after late 2021). ‘School closure’, ‘stay-at-home requirement’ and ‘testing policy’ were consistently associated with lower transmission across VOC phases. The impact of most PHSMs varied by VOC phases without clear increasing or decreasing trends as the pandemic progressed. Several PHSMs associated with lower transmission were not associated with fewer physical contacts. Conclusions: The impact of PHSMs evolved as the pandemic progressed—although without clear trends. The specific mechanisms by which some PHSMs reduce SARS-CoV-2 transmission require further research.Vaccine value profile for Klebsiella pneumoniae
AbstractDangor, Z., Benson, N., Berkley, J. A., Bielicki, J., Bijsma, M. W., Broad, J., Buurman, E. T., Cross, A., Duffy, E. M., Holt, K. E., Iroh Tam, P. Y., Jit, M., Karampatsas, K., Katwere, M., Kwatra, G., Laxminarayan, R., Le Doare, K., Mboizi, R., Micoli, F., … Madhi, S. A. (n.d.).Publication year
2024Journal title
VaccineVolume
42Issue
19Page(s)
S125-S141AbstractKlebsiella pneumoniae causes community- and healthcare-associated infections in children and adults. Globally in 2019, an estimated 1.27 million (95% Uncertainty Interval [UI]: 0.91–1.71) and 4.95 million (95% UI: 3.62–6.57) deaths were attributed to and associated with bacterial antimicrobial resistance (AMR), respectively. K. pneumoniae was the second leading pathogen in deaths attributed to AMR resistant bacteria. Furthermore, the rise of antimicrobial resistance in both community- and hospital-acquired infections is a concern for neonates and infants who are at high risk for invasive bacterial disease. There is a limited antibiotic pipeline for new antibiotics to treat multidrug resistant infections, and vaccines targeted against K. pneumoniae are considered to be of priority by the World Health Organization. Vaccination of pregnant women against K. pneumoniae could reduce the risk of invasive K. pneumoniae disease in their young offspring. In addition, vulnerable children, adolescents and adult populations at risk of K. pneumoniae disease with underlying diseases such as immunosuppression from underlying hematologic malignancy, chemotherapy, patients undergoing abdominal and/or urinary surgical procedures, or prolonged intensive care management are also potential target groups for a K. pneumoniae vaccine. A ‘Vaccine Value Profile’ (VVP) for K. pneumoniae, which contemplates vaccination of pregnant women to protect their babies from birth through to at least three months of age and other high-risk populations, provides a high-level, holistic assessment of the available information to inform the potential public health, economic and societal value of a pipeline of K. pneumoniae vaccines and other preventatives and therapeutics. This VVP was developed by a working group of subject matter experts from academia, non-profit organizations, public–private partnerships, and multi-lateral organizations, and in collaboration with stakeholders from the WHO. All contributors have extensive expertise on various elements of the K. pneumoniae VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using only existing and publicly available information."We usually see a lot of delay in terms of coming for or seeking care": an expert consultation on COVID testing and care pathways in low- and middle-income countries
AbstractBonnet, G., Bimba, J., Chavula, C., Chifamba, H. N., Divala, T., Lescano, A. G., Majam, M., Mbo, D., Suwantika, A. A., Tovar, M. A., Yadav, P., Corbett, E. L., Vassall, A., & Jit, M. (n.d.).Publication year
2023Journal title
Research squareAbstractRapid diagnostic testing may support improved treatment of COVID patients. Understanding COVID testing and care pathways is important for assessing the impact and cost-effectiveness of testing in the real world, yet there is limited information on these pathways in low-and-middle income countries (LMICs). We therefore undertook an expert consultation to better understand testing policies and practices, clinical screening, the profile of patients seeking testing or care, linkage to care after testing, treatment, lessons learnt and expected changes in 2023 in LMICs."We usually see a lot of delay in terms of coming for or seeking care": an expert consultation on COVID testing and care pathways in seven low- and middle-income countries
AbstractBonnet, G., Bimba, J., Chavula, C., Chifamba, H. N., Divala, T., Lescano, A. G., Majam, M., Mbo, D., Suwantika, A. A., Tovar, M. A., Yadav, P., Corbett, E. L., Vassall, A., & Jit, M. (n.d.).Publication year
2023Journal title
BMC health services researchVolume
23Issue
1Page(s)
1288AbstractRapid diagnostic testing may support improved treatment of COVID patients. Understanding COVID testing and care pathways is important for assessing the impact and cost-effectiveness of testing in the real world, yet there is limited information on these pathways in low-and-middle income countries (LMICs). We therefore undertook an expert consultation to better understand testing policies and practices, clinical screening, the profile of patients seeking testing or care, linkage to care after testing, treatment, lessons learnt and expected changes in 2023.Adding new childhood vaccines to China's National Immunization Program : evidence, benefits, and priorities
AbstractZhang, H., Lai, X., Patenaude, B. N., Jit, M., & Fang, H. (n.d.).Publication year
2023Journal title
The Lancet Public HealthVolume
8Issue
12Page(s)
e1016-e1024AbstractChina's National Immunization Program has made remarkable achievements but does not include several important childhood vaccines that are readily available in the private market, such as pneumococcal conjugate vaccine (PCV), rotavirus vaccine, Haemophilus influenzae serotype b (Hib) vaccine, and varicella vaccine. We reviewed the literature to assess these four non-National Immunization Program vaccines in terms of their disease burdens, coverage, inequalities, and cost-effectiveness in China and aimed to recommend priorities for introducing them to the National Immunization Program. Based on our calculations using the available evidence, incorporating these vaccines into China's National Immunization Program in 2019 could have averted 11 761 deaths among children younger than 5 years, accounting for 10·29% of the total deaths in children younger than 5 years and reducing the mortality rate from 7·8 per 1000 to 7·0 per 1000. The review showed that 13-valent PCV (PCV13) had the lowest and most inequitable coverage but could prevent the highest number of deaths. In a budgetary analysis for the cohort of newborns in 2023, we estimated that the projected aggregate government costs were US$1954·92 million for PCV13, $1273·13 million for pentavalent rotavirus vaccine, $415·30 million for Hib vaccine, and $221·64 million for varicella vaccine. Our overall multicriteria decision analysis suggested the following priority order for introducing these four non-programme vaccines to the National Immunization Program to benefit the Chinese population: PCV13, rotavirus vaccine, Hib vaccine, and varicella vaccine.Analyses of the return on investment of public health interventions : a scoping review and recommendations for future studies
AbstractTurner, H. C., Hori, Y., Revill, P., Rattanavipapong, W., Arai, K., Nonvignon, J., Jit, M., & Teerawattananon, Y. (n.d.).Publication year
2023Journal title
BMJ Global HealthVolume
8Issue
8AbstractReturn on investment (ROI) analysis is increasingly being used for evaluating the value for money of public health interventions. Given its potential role for informing health policies, it is important that there is a more comprehensive understanding of ROI analysis within the global health field. To address this gap in the literature, we conducted a scoping review of recent research articles reporting an ROI metric for a health intervention within the public sector in any country setting. The database search was limited to literature published in English and studies published between 1 January 2018 and 14 June 2021. Uses and settings where the ROI metric is being applied, key methodological features of the calculations and the types of economic benefits included were extracted. 118 relevant studies were included within this scoping review. We found that ROI analyses of health interventions differed between those that only included fiscal savings (such as prevented medical expenses) and those which incorporated a wider range of benefits (such as monetised health benefits). This highlights the variation in the definition of ROI analyses and supports the finding that ROI analyses are used for a range of different research questions/purposes within the healthcare sector. We also found that the methodologies used in ROI calculations were inconsistent and often poorly reported. This review demonstrates that there is notable variation in the methodology surrounding recent ROI calculations of healthcare interventions, as well as the definition of ROI analysis. We recommend that ROI metrics should be carefully interpreted before they are used to inform policy decisions regarding the allocation of healthcare resources. To improve the consistency of future studies, we also set out recommended use cases for ROI analysis and a reporting checklist.Assessing the impact of the 2018 Changchun Changsheng vaccine incident on childhood vaccination in China
AbstractHou, Z., Lai, X., Liu, Y., Jit, M., Larson, H. J., & Fang, H. (n.d.).Publication year
2023Journal title
Communications MedicineVolume
3Issue
1AbstractBackground: The 2018 Changchun Changsheng vaccine incident is an emergent public health event in China with reports of DTaP vaccines with compromised efficacy. This study aimed to estimate the impact of the vaccine incident on real-world vaccination behaviors in China. Methods: A cross-sectional survey was conducted in ten provinces in 2019. Vaccination records were collected from 5294 children aged 6-59 months, with information on 75,579 vaccine doses for seven National Immunization Program (NIP) vaccines and two non-NIP vaccines received from 2014 to 2019. Chi-square test, interrupted time series, and logistic regression were used to evaluate the impacts of vaccine incident on vaccination delay, measured as the proportion of delayed doses out of total doses in schedule. Results: Here we show significant increases in doses delayed ≤ 3 months (19.12% to 22.51%, p = 0.000) and > 3 months (7.17% to 11.82%, p = 0.000) for DTaP vaccine after the incident. By scaling nationally, there will be extra 2.1 million doses delayed ≤ 3 months and 2.8 million doses delayed > 3 months in the year following this incident. More guardians choose expensive private-market substitutes containing DTaP elements over government-funded DTaP vaccines. Controlling for socio-demographic factors, doses scheduled after the incident have higher odds of delays for DTaP vaccine (OR: 3.49, 95% CI: 3.08–3.96) and other NIP vaccines (OR: 2.76, 95% CI: 2.55–2.99), but not for non-NIP vaccines. Conclusions: The observed delays in the incident-involved DTaP vaccine immunization reflect the negative effects of the vaccine incident on vaccination behaviors under the NIP. However, its effects seem minimal for non-NIP vaccines.Assessing the impacts of COVID-19 vaccination programme’s timing and speed on health benefits, cost-effectiveness, and relative affordability in 27 African countries
AbstractLiu, Y., Procter, S. R., Pearson, C. A., Montero, A. M., Torres-Rueda, S., Asfaw, E., Uzochukwu, B., Drake, T., Bergren, E., Eggo, R. M., Ruiz, F., Ndembi, N., Nonvignon, J., Jit, M., & Vassall, A. (n.d.).Publication year
2023Journal title
BMC MedicineVolume
21Issue
1AbstractBackground: The COVID-19 vaccine supply shortage in 2021 constrained roll-out efforts in Africa while populations experienced waves of epidemics. As supply improves, a key question is whether vaccination remains an impactful and cost-effective strategy given changes in the timing of implementation. Methods: We assessed the impact of vaccination programme timing using an epidemiological and economic model. We fitted an age-specific dynamic transmission model to reported COVID-19 deaths in 27 African countries to approximate existing immunity resulting from infection before substantial vaccine roll-out. We then projected health outcomes (from symptomatic cases to overall disability-adjusted life years (DALYs) averted) for different programme start dates (01 January to 01 December 2021, n = 12) and roll-out rates (slow, medium, fast; 275, 826, and 2066 doses/million population-day, respectively) for viral vector and mRNA vaccines by the end of 2022. Roll-out rates used were derived from observed uptake trajectories in this region. Vaccination programmes were assumed to prioritise those above 60 years before other adults. We collected data on vaccine delivery costs, calculated incremental cost-effectiveness ratios (ICERs) compared to no vaccine use, and compared these ICERs to GDP per capita. We additionally calculated a relative affordability measure of vaccination programmes to assess potential nonmarginal budget impacts. Results: Vaccination programmes with early start dates yielded the most health benefits and lowest ICERs compared to those with late starts. While producing the most health benefits, fast vaccine roll-out did not always result in the lowest ICERs. The highest marginal effectiveness within vaccination programmes was found among older adults. High country income groups, high proportions of populations over 60 years or non-susceptible at the start of vaccination programmes are associated with low ICERs relative to GDP per capita. Most vaccination programmes with small ICERs relative to GDP per capita were also relatively affordable. Conclusion: Although ICERs increased significantly as vaccination programmes were delayed, programmes starting late in 2021 may still generate low ICERs and manageable affordability measures. Looking forward, lower vaccine purchasing costs and vaccines with improved efficacies can help increase the economic value of COVID-19 vaccination programmes.Challenges and opportunities in developing a Shigella-containing combination vaccine for children in low- and middle-income countries : Report of an expert convening
AbstractRiddle, M. S., Louis Bourgeois, A., Clifford, A., Jeon, S., Giersing, B. K., Jit, M., Tufet Bayona, M., Ovitt, J., & Hausdorff, W. P. (n.d.).Publication year
2023Journal title
VaccineVolume
41Issue
16Page(s)
2634-2644AbstractThe gram-negative bacterium Shigella is an enteric pathogen responsible for significant morbidity and mortality due primarily to severe diarrhea and dysentery, mainly among children younger than five years of age living in low- and middle-income countries (LMICs). Long considered a priority target for vaccine development, recent scientific advances have led to a number of promising Shigella vaccine candidates now entering advanced stages of clinical testing. Yet, there is no guarantee that even a highly efficacious Shigella vaccine will be recommended, prioritized, purchased, and widely adopted—especially if it requires additional doses in the immunization schedule and/or visits within the immunization program. This uncertainty is due to a variety of factors, including continuing declines in Shigella-specific and overall diarrheal disease mortality rates, the increasing complexity and cost of infant immunization programs in LMICs, and the recent availability of other high-priority vaccines. Since combining a Shigella vaccine with an existing infant vaccine would conceivably increase its attractiveness, there is a need to systematically consider the challenges determining the public health value, clinical development, manufacturing, licensure, policy recommendations, and financing for a Shigella-containing combination vaccine. The international non-governmental health organization PATH convened an independent panel of 34 subject matter experts across academic, industry, philanthropic, and global health sectors to discuss hypothetical combinations of a notional parenteral Shigella vaccine with three existing vaccines in order to begin exploring the challenges associated with their development. The resulting insights and recommendations from this meeting contribute to PATH's broader effort to evaluate the public health value of potential Shigella vaccines. They may also help guide future combination vaccine development efforts more broadly.Correspondence to : Estimating the full health and economic benefits of current and future influenza vaccines
AbstractWaterlow, N. R., Procter, S. R., Eggo, R. M., & Jit, M. (n.d.).Publication year
2023Journal title
BMC MedicineVolume
21Issue
1AbstractWe recently published an article in BMC Medicine looking at the potential health and economic impact of paediatric vaccination using next-generation influenza vaccines in Kenya: a modelling study. In their commentary on our article, Lafond et al. highlight the potential importance of the wider benefits of vaccination on cost-effectiveness. Whilst we agree with many points raised in the commentary, we think it raises further interesting discussion points, specifically around model complexity, model assumptions and data availability. These points are both relevant to this manuscript but have wider implications for vaccine cost-effectiveness studies.Cost-effectiveness of measles and rubella elimination in low-income and middle-income countries
AbstractLevin, A., Burgess, C., Shendale, S., Morgan, W., Cw Hutubessy, R., & Jit, M. (n.d.).Publication year
2023Journal title
BMJ Global HealthVolume
8Issue
7AbstractBackground Since 2000, the incidence of measles and rubella has declined as measles-rubella (MR) vaccine coverage increased due to intensified routine immunisation (RI) and supplementary immunisation activities (SIAs). The World Health Assembly commissioned a feasibility assessment of eliminating measles and rubella. The objective of this paper is to present the findings of cost-effectiveness analysis (CEA) of ramping up MR vaccination with a goal of eliminating transmission in every country. Methods We used projections of impact of routine and SIAs during 2018-2047 for four scenarios of ramping up MR vaccination. These were combined with economic parameters to estimate costs and disability-adjusted life years averted under each scenario. Data from the literature were used for estimating the cost of increasing routine coverage, timing of SIAs and introduction of rubella vaccine in countries. Results The CEA showed that all three scenarios with ramping up coverage above the current trend were more cost-effective in most countries than the 2018 trend for both measles and rubella. When the measles and rubella scenarios were compared with each other, the most cost-effective scenario was likely to be the most accelerated one. Even though this scenario is costlier, it averts more cases and deaths and substantially reduces the cost of treatment. Conclusions The Intensified Investment scenario is likely the most cost-effective of the vaccination scenarios evaluated for reaching both measles and rubella disease elimination. Some data gaps on costs of increasing coverage were identified and future efforts should focus on filling these gaps.Cost-effectiveness of monoclonal antibody and maternal immunization against respiratory syncytial virus (RSV) in infants : Evaluation for six European countries
Abstractfor Respiratory Syncytial Virus Consortium in Europe (RESCEU) investigators, A., Getaneh, A. M., Li, X., Mao, Z., Johannesen, C. K., Barbieri, E., van Summeren, J., Wang, X., Tong, S., Baraldi, E., Phijffer, E., Rizzo, C., van Wijhe, M., Heikkinen, T., Bont, L., Willem, L., Jit, M., Beutels, P., & Bilcke, J. (n.d.).Publication year
2023Journal title
VaccineVolume
41Issue
9Page(s)
1623-1631AbstractBackground: Respiratory syncytial virus (RSV) imposes a substantial burden on pediatric hospital capacity in Europe. Promising prophylactic interventions against RSV including monoclonal antibodies (mAb) and maternal immunizations (MI) are close to licensure. Therefore, we aimed to evaluate the cost-effectiveness of potential mAb and MI interventions against RSV in infants, for six European countries. Methods: We used a static cohort model to compare costs and health effects of four intervention programs to no program and to each other: year-round MI, year-round mAb, seasonal mAb (October to April), and seasonal mAb plus a catch-up program in October. Input parameters were obtained from national registries and literature. Influential input parameters were identified with the expected value of partial perfect information and extensive scenario analyses (including the impact of interventions on wheezing and asthma). Results: From the health care payer perspective, and at a price of €50 per dose (mAb and MI), seasonal mAb plus catch-up was cost-saving in Scotland, and cost-effective for willingness-to-pay (WTP) values ≥€20,000 (England, Finland) or €30,000 (Denmark) per quality adjusted life-year (QALY) gained for all scenarios considered, except when using ICD-10 based hospitalization data. For the Netherlands, seasonal mAb was preferred (WTP value: €30,000-€90,000) for most scenarios. For Veneto region (Italy), either seasonal mAb with or without catch-up or MI was preferred, depending on the scenario and WTP value. From a full societal perspective (including leisure time lost), the seasonal mAb plus catch-up program was cost-saving for all countries except the Netherlands. Conclusion: The choice between a MI or mAb program depends on the level and duration of protection, price, availability, and feasibility of such programs, which should be based on the latest available evidence. Future research should focus on measuring accurately age-specific RSV-attributable hospitalizations in very young children.Cost-effectiveness of pharmaceutical strategies to prevent respiratory syncytial virus disease in young children : a decision-support model for use in low-income and middle-income countries
AbstractMahmud, S., Baral, R., Sanderson, C., Pecenka, C., Jit, M., Li, Y., & Clark, A. (n.d.).Publication year
2023Journal title
BMC MedicineVolume
21Issue
1AbstractBackground: Respiratory syncytial virus (RSV) is a leading cause of respiratory disease in young children. A number of mathematical models have been used to assess the cost-effectiveness of RSV prevention strategies, but these have not been designed for ease of use by multidisciplinary teams working in low-income and middle-income countries (LMICs). Methods: We describe the UNIVAC decision-support model (a proportionate outcomes static cohort model) and its approach to exploring the potential cost-effectiveness of two RSV prevention strategies: a single-dose maternal vaccine and a single-dose long-lasting monoclonal antibody (mAb) for infants. We identified model input parameters for 133 LMICs using evidence from the literature and selected national datasets. We calculated the potential cost-effectiveness of each RSV prevention strategy (compared to nothing and to each other) over the lifetimes of all children born in the year 2025 and compared our results to a separate model published by PATH. We ran sensitivity and scenario analyses to identify the inputs with the largest influence on the cost-effectiveness results. Results: Our illustrative results assuming base case input assumptions for maternal vaccination ($3.50 per dose, 69% efficacy, 6 months protection) and infant mAb ($3.50 per dose, 77% efficacy, 5 months protection) showed that both interventions were cost-saving compared to status quo in around one-third of 133 LMICs, and had a cost per DALY averted below 0.5 times the national GDP per capita in the remaining LMICs. UNIVAC generated similar results to a separate model published by PATH. Cost-effectiveness results were most sensitive to changes in the price, efficacy and duration of protection of each strategy, and the rate (and cost) of RSV hospital admissions. Conclusions: Forthcoming RSV interventions (maternal vaccines and infant mAbs) are worth serious consideration in LMICs, but there is a good deal of uncertainty around several influential inputs, including intervention price, efficacy, and duration of protection. The UNIVAC decision-support model provides a framework for country teams to build consensus on data inputs, explore scenarios, and strengthen the local ownership and policy-relevance of results.Cost-Effectiveness of Respiratory Syncytial Virus Preventive Interventions in Children : A Model Comparison Study
AbstractREspiratory Syncytial virus Consortium in EUrope (RESCEU) Investigators, A., Li, X., Hodgson, D., Flaig, J., Kieffer, A., Herring, W. L., Beyhaghi, H., Willem, L., Jit, M., Bilcke, J., & Beutels, P. (n.d.).Publication year
2023Journal title
Value in HealthVolume
26Issue
4Page(s)
508-518AbstractObjectives: Model-based cost-effectiveness analyses on maternal vaccine (MV) and monoclonal antibody (mAb) interventions against respiratory syncytial virus (RSV) use context-specific data and produce varied results. Through model comparison, we aim to characterize RSV cost-effectiveness models and examine drivers for their outputs. Methods: We compared 3 static and 2 dynamic models using a common input parameter set for a hypothetical birth cohort of 100 000 infants. Year-round and seasonal programs were evaluated for MV and mAb interventions, using available evidence during the study period (eg, phase III MV and phase IIb mAb efficacy). Results: Three static models estimated comparable medically attended (MA) cases averted versus no intervention (MV, 1019-1073; mAb, 5075-5487), with the year-round MV directly saving ∼€1 million medical and €0.3 million nonmedical costs, while gaining 4 to 5 discounted quality-adjusted life years (QALYs) annually in