Thank you Josh. I’ve found 1Day Sooner’s collaborative spirit to be exemplary here—both being welcoming of the challenge and adding useful thoughts.
It seems intuitive to me that the following package of considerations may lead to vaccines and nets/SMC having roughly the same cost-effectiveness:
vaccines are 10x (ish) more expensive (bad for vaccines)
vaccines are more targeted at the most vulnerable ages (good for vaccines)
misc other considerations, like insecticide resistance (this is a bit hand-wavey at the moment, but I guess probably nets out to being good for vaccines)
A hint at the possibility that this might end up with similar cost-effectiveness is the Imperial/Oxford study that Josh mentioned.
Other considerations include:
Replicability: when we create these sorts of models, we don’t normally give 100% credit to the efficacy figures for vaccines. Rather we recognise there isn’t yet a large evidence base, and typically the efficacy is more likely to go down than up with more evidence; estimating how much it would go down by as we got more and more evidence is sometimes called an internal validity adjustment, or replicability adjustment.
For bednets this is negligible (adjust by 5%), and with good reason—nets are a very well-established intervention with plenty of evidence
I expect that such an adjustment for vaccines might be significantly less favourable, but I’d need to look at the evidence properly to say anything more precise than that
My best guess, having not researched it properly, is that the cost-effectiveness of the R21 vaccine probably will still be clearly behind that of existing interventions (bednets/SMC), but it may well be above the cost-effectiveness thresholds of the bodies you’re advocating to (e.g. because they are large aid agencies with large budgets), meaning that the advocacy still makes sense. I wouldn’t be surprised if either of these guesses were incorrect
Thank you Josh. I’ve found 1Day Sooner’s collaborative spirit to be exemplary here—both being welcoming of the challenge and adding useful thoughts.
It seems intuitive to me that the following package of considerations may lead to vaccines and nets/SMC having roughly the same cost-effectiveness:
vaccines are 10x (ish) more expensive (bad for vaccines)
vaccines are more targeted at the most vulnerable ages (good for vaccines)
misc other considerations, like insecticide resistance (this is a bit hand-wavey at the moment, but I guess probably nets out to being good for vaccines)
A hint at the possibility that this might end up with similar cost-effectiveness is the Imperial/Oxford study that Josh mentioned.
Other considerations include:
Replicability: when we create these sorts of models, we don’t normally give 100% credit to the efficacy figures for vaccines. Rather we recognise there isn’t yet a large evidence base, and typically the efficacy is more likely to go down than up with more evidence; estimating how much it would go down by as we got more and more evidence is sometimes called an internal validity adjustment, or replicability adjustment.
For bednets this is negligible (adjust by 5%), and with good reason—nets are a very well-established intervention with plenty of evidence
I expect that such an adjustment for vaccines might be significantly less favourable, but I’d need to look at the evidence properly to say anything more precise than that
My best guess, having not researched it properly, is that the cost-effectiveness of the R21 vaccine probably will still be clearly behind that of existing interventions (bednets/SMC), but it may well be above the cost-effectiveness thresholds of the bodies you’re advocating to (e.g. because they are large aid agencies with large budgets), meaning that the advocacy still makes sense. I wouldn’t be surprised if either of these guesses were incorrect