The burden of malaria as it exists right now, exists even amidst the decades of use of all the available interventions (including ITNs and chemotherapies). Is there any progression of To add to that, compliance in the use of the ITNs is also challenge (several reports exists on how ITNs in Africa end up being used for fishing, or how some resell them. The ITNs reduce all cause mortality by 17% and the RTS’S vaccine reduces mortality by 13% and the projection for R21 is expected to be higher when the data becomes available.
I am not 100% certain that I follow all the math. However, when it comes to the malaria burden and which intervention is most cost effective, the general rule I’d apply is the permanence of the intervention. An intervention such as the use of ITNs may appear cost effective if you view it in a period of maximum 3 years. But because such an intervention is not permanent, the need to replenish ITN supplies to households repeatedly means that nets are a recurring cost. This implies that the actual cost of ITNs can’t fully be quantified in the sense of how long malaria as a disease will continue to exist. Vaccines on the other hand are more permanent and have a predictive cost even when measured against waning immunity.
Vaccines will bring us closer towards herd immunity and potentially the elimination of malaria and vaccines must be used complimentary to other interventions in the malaria toolkit.
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.
The burden of malaria as it exists right now, exists even amidst the decades of use of all the available interventions (including ITNs and chemotherapies). Is there any progression of To add to that, compliance in the use of the ITNs is also challenge (several reports exists on how ITNs in Africa end up being used for fishing, or how some resell them. The ITNs reduce all cause mortality by 17% and the RTS’S vaccine reduces mortality by 13% and the projection for R21 is expected to be higher when the data becomes available.
I am not 100% certain that I follow all the math. However, when it comes to the malaria burden and which intervention is most cost effective, the general rule I’d apply is the permanence of the intervention. An intervention such as the use of ITNs may appear cost effective if you view it in a period of maximum 3 years. But because such an intervention is not permanent, the need to replenish ITN supplies to households repeatedly means that nets are a recurring cost. This implies that the actual cost of ITNs can’t fully be quantified in the sense of how long malaria as a disease will continue to exist. Vaccines on the other hand are more permanent and have a predictive cost even when measured against waning immunity.
Vaccines will bring us closer towards herd immunity and potentially the elimination of malaria and vaccines must be used complimentary to other interventions in the malaria toolkit.
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.