Seems like this is an investment related to the Global Plan to End TB, 2023-2030. Over the period they call for ~250 billion USD in funding[1]. They state that in the status quo scenario we lose 234 million DALYs[2] to TB. It’s a little hard to get the exact number, but looks like they aim to reduce this by around 50% over the period as a whole (?). Around 2 000 USD per DALY on average, which is a fair bit higher than what GiveWell cites for their top charities. I should note that some of the costs are in R&D which will pay dividends beyond 2030.
Given that they aim to reduce TB, cases and deaths, by 80% and 90% respectively in 2030[3], I’m guessing that some of the work should be substantially more cost-effective than the average.
I’ve not dug into the plan at all I only skimmed the headline numbers, but an interesting read nonetheless!
GiveWell has done some work on TB, but I’m not sure what their overall views are on the area. They recently pulled out of an RCT for a screening program (for unknown reasons?). As far as I can gather there was quite a lot of activity around 2009-2010, with Holden going so far as to personally give to Stop Tuberculosis Partnership. Seems like it was a top rated charity at the time.
If anyone has a good feel for what GiveWell thinks about the area I’d be very interested to hear about it! Or some pointers to where I can learn more.
Just wanted to thank you and NickLaing for this exchange. I’m planning to use an adapted version of the thoughts/considerations as an example of estimating expected value in some resources I’m creating!
Working on a new, more effective TB vaccine: Cost per life saved?
About 50% of phase 3 trials are successful. So 50% chance of the rollout being possible
Being conservative on The Economist’s optimistic estimate of 10 million lives saved, let’s reduce it to [BLANK 1].
So 0.5 (probability) x [BLANK 1] (lives saved) = [BLANK 2] lives saved in expectation.
The trial is $550 million to open up this opportunity, then let’s estimate vaccine production and distribution costs $5 per person.
There are about 7 times as many TB cases as deaths, but the vaccine is maximum about 50% effective, and they’ll have to vaccinate way more people than currently actually get TB. So let’s guess that they need to vaccinate [BLANK 3] people to save the [BLANK 1] lives
[BLANK 3] million x $5 = $[BLANK 4] in distribution costs.
I would say this vaccine work could be far more cost-effective than the average spending on the global plan to end TB. Because of the nature of the disease (long follow up, long expensive treatment), TB costs so much money to treat and follow up compared with other diseases. Lets have a go at some Napkin calculations for potential vaccine cost-effectiveness?!
About 50% of phase 3 trials are successful, so that’s easy to adjust for. So 50% chance of the rollout being possible
Being conservative on their optimistic estimate of 10 million lives saved, lets reduce that by 80% to 2 million. Each life saved could be equivalent to 20 DALYs averted, given TB kills a lot of older people as well.
Remember here though we haven’t included DALYs of those who were saved from suffering but wouldn’t have died from TB so I think that makes this quite conservative. TB is unlike malaria in that because its a long and hard to cure disease suffering is a huge factor—I would imagine average suffering for the average person who doesn’t die TB might well be over 1 DALY (it has probably been calculated somewhere)
So 0.5 (probability of trial success at current 50% prevention rate) x 20 (DALYs averted per life saved) x 2,000,000 (Lives saved) = 20,000,000 DALYs
20 million DALYS averted in the next 25 years (Not before 2030 mind you).
The trial is 550 million dollars to open up this opportunity, then I’m going to pretty randomly estimate vaccine ends up costing $5 per person (not sure how many doses are needed or production) to produce in the Indian factory like they have planned and distribute. If they vaccinate 500 million people that’s estimated 2.5 billion in distribution costs. I could have massively over/underestimated the cost here. So 3 billion dollars all up, to prevent 20 million DALYs
$3,000,000,000 (cost) / 20,000,000 DALYs
That’s an EV of about $150 a DALY, closer to GiveWell. And this might look much better value after suffering for non-deaths is factored in.
Obviously this is a 10 minute calculation with ludicrous error and probably large mistakes, but I think its still useful to have a go!
I have no idea what’s needed in terms of production costs, distribution costs etc. but it’s an interesting back of the envelope calculation nevertheless.
In the report I’ve referenced they project around 12-14 billion USD for vaccinations from 2027 to and including 2030, summing to around 50 billion. And this is assuming the vaccine has been developed. They put another 10 billion on top for vaccine R&D.
This is what they write in the report:
Adequate funding must be mobilized to support the manufacturing, procurement and distribution of vaccines, especially in high-burden settings.
This ist he first Global Plan to estimate the costs for rolling out new TB vaccines. Global costs to implement a new vaccine are projected to average US$ 13.15 billion annually from 2027 through 2030, totalling US$ 52.6 billion. Modelled cost estimates include costs to scale up the use of a two-dose TB vaccine, reaching at least 60% of adults and adolescents by 2028, and to maintain 60% coverage or more after that. The cost of vaccine dose units and the operational cost for vaccine delivery have been informed by the experience of rolling out COVID-19 vaccines.
I did read parts of chapter 9 on costs to try to get a better picture of what goes into these estimates, but didn’t find anything very detailed in my quick scan. So I’m not sure exactly how they come up with these numbers.
It does seem that this is assuming world-wide distribution, and that the costs vary quite a bit depending on the particulars of any specific region. See f.ex. Table 19 on page 145 in the report.
Thanks you’ve put some effort into reading that article nice one.
From what I could see it lookked to me like they were looking at the total cost of developing and rolling out a new vaccine.
“In the report I’ve referenced they project around 12-14 billion USD for vaccinations from 2027 to and including 2030, summing to around 50 billion. And this is assuming the vaccine has been developed. They put another 10 billion on top for vaccine R&D.”
- Where did you get that from?” I couldn’t find the 10 billion figure for R&D I thought that was part of their total.
I don’t think they had this far cheaper situation mind which has already been developed and now “just” needs phase 3 tryial and manufacture/distribution. Also plans are already underway to minimise costs in an Indian factory. Costs vary wildly with vaccines—for example the covax vaccine was more like 5 dollars a dose (which I used as my figure here), wheras Moderna and other RNA vaccines were closer to 20. That’s a factor of 4 already. I’d imagine the Gates foundation will do a decent job of keeping prices down, who knows maybe even by a factor of 5-10x compared with if it was manfactured commercially in say America.
The article doesn’t talk much at all about they get their numbers which is a little annoying.
I did a little more digging, and through a WHO report referenced by the Gates Foundation in their article, I think I’ve found something that could be the source of the claims in the report I skimmed.
Portnoy, A., et al. (2022). The cost and cost-effectiveness of novel tuberculosis vaccines in low- and middle-income countries: a modelling study. medRxiv, 2022.05.04.22274654. doi: https://doi.org/10.1101/2022.05.04.22274654
Interestingly, the baseline scenario assumes a vaccine price similar to you, around 5 USD per dose in a 2-dose regiment, which in my naive reading seems to confirm that the bulk of the costs are in fact in logistics. Of course, the headline is that even if the costs here are higher than one would like, it’s still hugely cost-effective in terms of return on investment, and great news for the world as a whole!
Even if (on an extremely shallow read) it seems like it doesn’t quite cross GiveWell’s bar for cost-effectiveness. Unless I am confused about something. Again, if anyone knows if GiveWell has a take on this, I’d be very happy to see :)
“In the report I’ve referenced they project around 12-14 billion USD for vaccinations from 2027 to and including 2030, summing to around 50 billion. And this is assuming the vaccine has been developed. They put another 10 billion on top for vaccine R&D.”—
Where did you get that from?” I couldn’t find the 10 billion figure for R&D I thought that was part of their total.
Thanks for pointing out I forgot to mention where I got that from! It’s from Table B. Resources needed to accelerate R&D of new TB tools, 2023–2030, page 15 in the report.
I’m sure gates foundation are working very hard on keeping costs down, and let’s hope they succeed! I do have a feeling that the bulk of the costs for vaccinations come from the distribution and logistics rather than the production costs, but this is just my vague intuition.
New Incentives, a GiveWell recommended charity, uses roughly 100 USD per vaccination.
I’m not sure how this new trial impacts Stop TB Partnership’s expectations for development costs, but hopefully it turns out to be much cheaper than their expert group estimated at the time of the report being written :)
If you have the time I’m sure they’d be happy to answer an email!
We were very excited to learn of this trial, a much-needed step toward reducing deaths from tuberculosis. We applaud Gates and Wellcome for this sizable commitment of resources, which is, as Nick points out, necessary to gain adequate information about the vaccine’s efficacy, but beyond the reach of most funders.
We have investigated TB-related funding opportunities, and we remain very open to funding either programs or research. However, we have several significant uncertainties about the programs we’ve explored so far and have not yet funded any at scale.
We are working on a report summarizing the evidence for mass TB screen-and-treat programs, which will provide more detail on our views specific to that type of program.
Very cool!
Seems like this is an investment related to the Global Plan to End TB, 2023-2030. Over the period they call for ~250 billion USD in funding[1]. They state that in the status quo scenario we lose 234 million DALYs[2] to TB. It’s a little hard to get the exact number, but looks like they aim to reduce this by around 50% over the period as a whole (?). Around 2 000 USD per DALY on average, which is a fair bit higher than what GiveWell cites for their top charities. I should note that some of the costs are in R&D which will pay dividends beyond 2030.
Given that they aim to reduce TB, cases and deaths, by 80% and 90% respectively in 2030[3], I’m guessing that some of the work should be substantially more cost-effective than the average.
I’ve not dug into the plan at all I only skimmed the headline numbers, but an interesting read nonetheless!
GiveWell has done some work on TB, but I’m not sure what their overall views are on the area. They recently pulled out of an RCT for a screening program (for unknown reasons?). As far as I can gather there was quite a lot of activity around 2009-2010, with Holden going so far as to personally give to Stop Tuberculosis Partnership. Seems like it was a top rated charity at the time.
If anyone has a good feel for what GiveWell thinks about the area I’d be very interested to hear about it! Or some pointers to where I can learn more.
Page 14, under “Resource needs”, The Global Plan to End TB 2023-2030 [PDF]
Page 14, under “The cost of inaction”, The Global Plan to End TB 2023-2030 [PDF]
Page 15, under “Projected impact”, The Global Plan to End TB 2023-2030 [PDF]
Just wanted to thank you and NickLaing for this exchange. I’m planning to use an adapted version of the thoughts/considerations as an example of estimating expected value in some resources I’m creating!
Working on a new, more effective TB vaccine: Cost per life saved?
About 50% of phase 3 trials are successful. So 50% chance of the rollout being possible
Being conservative on The Economist’s optimistic estimate of 10 million lives saved, let’s reduce it to [BLANK 1].
So 0.5 (probability) x [BLANK 1] (lives saved) = [BLANK 2] lives saved in expectation.
The trial is $550 million to open up this opportunity, then let’s estimate vaccine production and distribution costs $5 per person.
There are about 7 times as many TB cases as deaths, but the vaccine is maximum about 50% effective, and they’ll have to vaccinate way more people than currently actually get TB. So let’s guess that they need to vaccinate [BLANK 3] people to save the [BLANK 1] lives
[BLANK 3] million x $5 = $[BLANK 4] in distribution costs.
$0.55 billion (trial costs) + $[BLANK 4] (distribution costs) = $[BLANK 5]
$[BLANK 5] (cost) / [BLANK 2] (lives saved in expectation) = $[BLANK 6] per life saved in expectation
Great comment thank you!
I would say this vaccine work could be far more cost-effective than the average spending on the global plan to end TB. Because of the nature of the disease (long follow up, long expensive treatment), TB costs so much money to treat and follow up compared with other diseases. Lets have a go at some Napkin calculations for potential vaccine cost-effectiveness?!
About 50% of phase 3 trials are successful, so that’s easy to adjust for. So 50% chance of the rollout being possible
Being conservative on their optimistic estimate of 10 million lives saved, lets reduce that by 80% to 2 million. Each life saved could be equivalent to 20 DALYs averted, given TB kills a lot of older people as well.
Remember here though we haven’t included DALYs of those who were saved from suffering but wouldn’t have died from TB so I think that makes this quite conservative. TB is unlike malaria in that because its a long and hard to cure disease suffering is a huge factor—I would imagine average suffering for the average person who doesn’t die TB might well be over 1 DALY (it has probably been calculated somewhere)
So 0.5 (probability of trial success at current 50% prevention rate) x 20 (DALYs averted per life saved) x 2,000,000 (Lives saved) = 20,000,000 DALYs
20 million DALYS averted in the next 25 years (Not before 2030 mind you).
The trial is 550 million dollars to open up this opportunity, then I’m going to pretty randomly estimate vaccine ends up costing $5 per person (not sure how many doses are needed or production) to produce in the Indian factory like they have planned and distribute. If they vaccinate 500 million people that’s estimated 2.5 billion in distribution costs. I could have massively over/underestimated the cost here. So 3 billion dollars all up, to prevent 20 million DALYs
$3,000,000,000 (cost) / 20,000,000 DALYs
That’s an EV of about $150 a DALY, closer to GiveWell. And this might look much better value after suffering for non-deaths is factored in.
Obviously this is a 10 minute calculation with ludicrous error and probably large mistakes, but I think its still useful to have a go!
Indeed, inspiring stuff!
I have no idea what’s needed in terms of production costs, distribution costs etc. but it’s an interesting back of the envelope calculation nevertheless.
In the report I’ve referenced they project around 12-14 billion USD for vaccinations from 2027 to and including 2030, summing to around 50 billion. And this is assuming the vaccine has been developed. They put another 10 billion on top for vaccine R&D.
This is what they write in the report:
I did read parts of chapter 9 on costs to try to get a better picture of what goes into these estimates, but didn’t find anything very detailed in my quick scan. So I’m not sure exactly how they come up with these numbers.
It does seem that this is assuming world-wide distribution, and that the costs vary quite a bit depending on the particulars of any specific region. See f.ex. Table 19 on page 145 in the report.
Thanks you’ve put some effort into reading that article nice one.
From what I could see it lookked to me like they were looking at the total cost of developing and rolling out a new vaccine.
“In the report I’ve referenced they project around 12-14 billion USD for vaccinations from 2027 to and including 2030, summing to around 50 billion. And this is assuming the vaccine has been developed. They put another 10 billion on top for vaccine R&D.”
- Where did you get that from?” I couldn’t find the 10 billion figure for R&D I thought that was part of their total.
I don’t think they had this far cheaper situation mind which has already been developed and now “just” needs phase 3 tryial and manufacture/distribution. Also plans are already underway to minimise costs in an Indian factory. Costs vary wildly with vaccines—for example the covax vaccine was more like 5 dollars a dose (which I used as my figure here), wheras Moderna and other RNA vaccines were closer to 20. That’s a factor of 4 already. I’d imagine the Gates foundation will do a decent job of keeping prices down, who knows maybe even by a factor of 5-10x compared with if it was manfactured commercially in say America.
The article doesn’t talk much at all about they get their numbers which is a little annoying.
I did a little more digging, and through a WHO report referenced by the Gates Foundation in their article, I think I’ve found something that could be the source of the claims in the report I skimmed.
Portnoy, A., et al. (2022). The cost and cost-effectiveness of novel tuberculosis vaccines in low- and middle-income countries: a modelling study. medRxiv, 2022.05.04.22274654. doi: https://doi.org/10.1101/2022.05.04.22274654
Interestingly, the baseline scenario assumes a vaccine price similar to you, around 5 USD per dose in a 2-dose regiment, which in my naive reading seems to confirm that the bulk of the costs are in fact in logistics. Of course, the headline is that even if the costs here are higher than one would like, it’s still hugely cost-effective in terms of return on investment, and great news for the world as a whole!
Even if (on an extremely shallow read) it seems like it doesn’t quite cross GiveWell’s bar for cost-effectiveness. Unless I am confused about something. Again, if anyone knows if GiveWell has a take on this, I’d be very happy to see :)
Thanks for pointing out I forgot to mention where I got that from! It’s from Table B. Resources needed to accelerate R&D of new TB tools, 2023–2030, page 15 in the report.
I’m sure gates foundation are working very hard on keeping costs down, and let’s hope they succeed! I do have a feeling that the bulk of the costs for vaccinations come from the distribution and logistics rather than the production costs, but this is just my vague intuition.
New Incentives, a GiveWell recommended charity, uses roughly 100 USD per vaccination.
I’m not sure how this new trial impacts Stop TB Partnership’s expectations for development costs, but hopefully it turns out to be much cheaper than their expert group estimated at the time of the report being written :)
If you have the time I’m sure they’d be happy to answer an email!
Hi, Hakon,
We were very excited to learn of this trial, a much-needed step toward reducing deaths from tuberculosis. We applaud Gates and Wellcome for this sizable commitment of resources, which is, as Nick points out, necessary to gain adequate information about the vaccine’s efficacy, but beyond the reach of most funders.
We have investigated TB-related funding opportunities, and we remain very open to funding either programs or research. However, we have several significant uncertainties about the programs we’ve explored so far and have not yet funded any at scale.
We are working on a report summarizing the evidence for mass TB screen-and-treat programs, which will provide more detail on our views specific to that type of program.
Best, Miranda
Fantastic, thanks for the update Miranda!