Thanks Zacharia, I think you make some interesting points but I disagree with much of the substance here. My overall point would be, that when we talk about cost-effectiveness a lot of it is a question of math, so I don’t think its necessarily helpful to try and apply overarching “rules” or “principles” to cost-effectiveness calculations. Better I think to just take all the steps as dispassionately as possible needed to make an accurate estimate, leaving pre-determined principles out of it.
But to respond to your specific points...
The current vaccine efficacy seems to start waning after 18 months, so I’m not sure why you are talking about vaccines being a more “permanent” solution. The current vaccines need to be “replenished” similar to mosquito nets. Interestingly though 3ish years of protection either from nets or a vaccine might be enough to get a child through the most malaria-deadly period of their life.
Even if the vaccines lasted a lot longterm I don’t think “permanence” is a good general rule to apply to see how cost-effective an intervention might be. What matters more is how many lives will be saved (or DALYs averted), and how much the intervention will cost. Obviously the longer an intervention lasts (the more permanent it is) the more likely the intervention to be cost-effective.
I don’t think the current vaccines with their mediocre efficacy bring us anywhere near even the most liberal application of “herd immunity” (and I don’t think anyone is claiming they do). Sure with new close to 100% effective vaccines we could start thinking about herd immunity and the insanely high potential cost-effectiveness of elimination but there’s nothing even on the horizon which is yet even close to this good.
Thanks Zacharia, I think you make some interesting points but I disagree with much of the substance here. My overall point would be, that when we talk about cost-effectiveness a lot of it is a question of math, so I don’t think its necessarily helpful to try and apply overarching “rules” or “principles” to cost-effectiveness calculations. Better I think to just take all the steps as dispassionately as possible needed to make an accurate estimate, leaving pre-determined principles out of it.
But to respond to your specific points...
The current vaccine efficacy seems to start waning after 18 months, so I’m not sure why you are talking about vaccines being a more “permanent” solution. The current vaccines need to be “replenished” similar to mosquito nets. Interestingly though 3ish years of protection either from nets or a vaccine might be enough to get a child through the most malaria-deadly period of their life.
Even if the vaccines lasted a lot longterm I don’t think “permanence” is a good general rule to apply to see how cost-effective an intervention might be. What matters more is how many lives will be saved (or DALYs averted), and how much the intervention will cost. Obviously the longer an intervention lasts (the more permanent it is) the more likely the intervention to be cost-effective.
I don’t think the current vaccines with their mediocre efficacy bring us anywhere near even the most liberal application of “herd immunity” (and I don’t think anyone is claiming they do). Sure with new close to 100% effective vaccines we could start thinking about herd immunity and the insanely high potential cost-effectiveness of elimination but there’s nothing even on the horizon which is yet even close to this good.