My two cents, leaning (weakly) towards there being a danger of comparing apples to oranges, and ‘red teaming’ being more valuable when more data is available.
Much of the cost of the malaria vaccine will be borne by governments or non-EA international aid (current $25 cost-estimate of a programme may also include committed govt health spend on vaccination infrastructure)
afaik the marginal cost per impact of a hypothetical EA vaccine rollout funding program is currently unknown and likely lower than current total cost per vaccination estimate
other organizations involved already fund many interventions with weaker cost/benefit and ring fence causes, so them diverting funding to malaria vaccination may be significantly net positive even if better interventions exist
Cost effectiveness has already been a consideration for those involved in the programmes.(most notably the Gates Foundation dropped out of funding RTS’S primarily based on cost-effectiveness related concerns. I am not sure of their position on R21 or if it is still evolving). So it hasn’t been neglected and public-facing critical analysis may already be available.
It’s unlikely ‘red teaming’ medical trials will uncover the sort of methodological flaws present in less rigorous RCTs and analysis of more speculative causal relationships.
Vaccination is intended to be a complement rather than a substitute for nets/SMC and an idealised antimalarial intervention should include both.
BOTEC calculation based on above figures $27 for an 88% reduction; likely to compare very favourably with most global health interventions
I suspect most of the funding for the vaccination program won’t be diverted from bednets or other extremely cost effective interventions, and organisations which backed vaccine development continue to spend on bed nets
The efficacy criteria are not equivalent as the 55% of [severe] malarial cases not prevented by nets represent cases where the nets have no effect (e.g. daytime infections) whereas the vaccination may still have had a positive immune effect on the the 23% of clinical malarial cases still diagnosed post-vaccination. Long term economic and health impacts of a vaccine attenuating [still severe] malaria infection even where symptoms exist are outside the scope of evidence collected, but plausibly significant.
Malaria vaccination is a new programme involving many non-EA stakeholders and facing numerous political and logistical challenges to roll out. Caution is needed to avoid “red team” material being misinterpreted as arguing R21 is ineffective or poor value relative to the median global healthcare intervention rather than relative to the most cost-effective interventions studied; perfect can be the enemy of good. Current evidence suggests the interventions are cost effective relative to many global health programs with public support, and on a cost-neutral basis R21 appears significantly more effective than other standalone antimalarial interventions
Downside risk is greater if the preliminary data overstates marginal costs or underestimates long-term benefit (plausibly both)
Likelihood and salience of misinterpretation lower (and benefit of analysis of more up-to-date data/estimates higher) after govt commitments made, with research more likely to be appropriately used by EAs exploring a specific donation option
I would update the other way if there are major institutional donors ready but unwilling to commit in the absence of thorough independent study. Ideally, these are the sort of donors that ought to be willing to fund you too!
(Disclaimer: not a sector expert. I may help 1Day Sooner with their request for ad hoc research task support in the near future but opinions and any errors are entirely mine)
My two cents, leaning (weakly) towards there being a danger of comparing apples to oranges, and ‘red teaming’ being more valuable when more data is available.
Much of the cost of the malaria vaccine will be borne by governments or non-EA international aid (current $25 cost-estimate of a programme may also include committed govt health spend on vaccination infrastructure)
afaik the marginal cost per impact of a hypothetical EA vaccine rollout funding program is currently unknown and likely lower than current total cost per vaccination estimate
other organizations involved already fund many interventions with weaker cost/benefit and ring fence causes, so them diverting funding to malaria vaccination may be significantly net positive even if better interventions exist
Cost effectiveness has already been a consideration for those involved in the programmes.(most notably the Gates Foundation dropped out of funding RTS’S primarily based on cost-effectiveness related concerns. I am not sure of their position on R21 or if it is still evolving). So it hasn’t been neglected and public-facing critical analysis may already be available.
It’s unlikely ‘red teaming’ medical trials will uncover the sort of methodological flaws present in less rigorous RCTs and analysis of more speculative causal relationships.
Vaccination is intended to be a complement rather than a substitute for nets/SMC and an idealised antimalarial intervention should include both.
BOTEC calculation based on above figures $27 for an 88% reduction; likely to compare very favourably with most global health interventions
I suspect most of the funding for the vaccination program won’t be diverted from bednets or other extremely cost effective interventions, and organisations which backed vaccine development continue to spend on bed nets
The efficacy criteria are not equivalent as the 55% of [severe] malarial cases not prevented by nets represent cases where the nets have no effect (e.g. daytime infections) whereas the vaccination may still have had a positive immune effect on the the 23% of clinical malarial cases still diagnosed post-vaccination. Long term economic and health impacts of a vaccine attenuating [still severe] malaria infection even where symptoms exist are outside the scope of evidence collected, but plausibly significant.
Malaria vaccination is a new programme involving many non-EA stakeholders and facing numerous political and logistical challenges to roll out. Caution is needed to avoid “red team” material being misinterpreted as arguing R21 is ineffective or poor value relative to the median global healthcare intervention rather than relative to the most cost-effective interventions studied; perfect can be the enemy of good. Current evidence suggests the interventions are cost effective relative to many global health programs with public support, and on a cost-neutral basis R21 appears significantly more effective than other standalone antimalarial interventions
Downside risk is greater if the preliminary data overstates marginal costs or underestimates long-term benefit (plausibly both)
Likelihood and salience of misinterpretation lower (and benefit of analysis of more up-to-date data/estimates higher) after govt commitments made, with research more likely to be appropriately used by EAs exploring a specific donation option
I would update the other way if there are major institutional donors ready but unwilling to commit in the absence of thorough independent study. Ideally, these are the sort of donors that ought to be willing to fund you too!
(Disclaimer: not a sector expert. I may help 1Day Sooner with their request for ad hoc research task support in the near future but opinions and any errors are entirely mine)