Almost 35,000 lives could be saved by an Indian government vaccination drive targeting one of the country’s biggest killers of children under five: pneumonia. Plans from the Centre are currently in place for a nationwide rollout of the pneumococcal conjugate vaccine (PCV). This plan could significantly reduce the incidence of diseases such as pneumonia, which current estimates claim is responsible for 1.8 lakh child deaths a year.
However, the plan must account for the fact that the PCV vaccine is considerably more expensive than any other vaccine currently on the list of India’s Universal Immunisation Programme (UIP).
There is also only a small amount of data currently available on the vaccine’s efficacy within the context of lower middle-income countries such as India. As such some doubt the cost-effectiveness of integrating of PCV vaccine into the UIP. A recent study conducted by researchers at the University of Strathclyde in the UK and the Center for Disease Dynamics Economics and Policy in the US and India could allay some of these doubts.
The study, published in the BMJ Global Health, concludes the programme could prevent 34,800 under-five deaths. While the projected cost of the programme is significant, at an estimated Rs 1,600 crore (240 million USD), it could be offset by potential savings of 48.7 million USD in treatment costs annually for families.
The study found that the majority of the patient savings would occur among the lowest earning quintiles. This is important as it implies that the implementation of the vaccine could reduce catastrophic out-of-pocket spending on healthcare for those who are least capable of affording it.
Studies have shown that 65.6 percent of healthcare expenditure in India is out of pocket (i.e. paid for by the patients themselves).
A large swathe of this expenditure occurs in private health outlets, which often charge significantly more than public health facilities for equivalent services. Current estimates indicate that private healthcare providers supply eighty percent of outpatient care and sixty percent of inpatient care. It is believed that out-of-pocket expenditure for services by private hospitals places 55 million Indians into poverty each year. Measures to alleviate this high financial burden will likely come as a relief to numerous patients
The impact could be even greater, in terms of lives saved. While the study posits the figure of 34,800 the researchers note that these figures are highly conservative. Real-world outcomes are likely to be even more positive, with the potential for more money saved due to a reduced disease burden and less related disability and fewer deaths.
The study makes use of “IndiaSim”, an agent based simulation model representative of the Indian population and health system. Using this, researchers plotted the levels of disease incidence and evaluated the serotype and overall disease dynamics in the context of the local population and health system.
The assumption made as part of the simulations was that distribution levels would be similar to that of the DPT (diphtheria, pertussis and tetanus) vaccination, or roughly 77 percent. It is from this immunisation coverage figure that all projected expenditure and savings were calculated.
Increasing the coverage level to ninety percent was found to be the most cost-effective outcome in over 95 percent of simulated outcomes. This displays the importance of greater immunisation coverage, as even with 77 percent vaccination coverage there still lies the potential for pneumonia to spread to unvaccinated individuals.
The computational analysis of the Indian healthcare model was stated to suffer from lack of data in certain areas. This is likely to correspond to rural areas or tribal locations where healthcare infrastructure is typically more lacking. Due to this the information regarding pneumonia distribution and rates may be lacking or entirely absent.
Due to this, caution is advised in using the results of the study. The results are speculative, though have been run through numerous simulations to assess the greatest impact. However, the PCV has not been tested in a low-to-middle income setting, and even in high-income nations the efficacy varied depending on the pneumococcal strains present.
However, when taking into account the full economic implications of pneumonia, the PCV may indeed be cost efficient despite its high price.
Pneumonia cases can lead to fairly long periods of time an individual may take off from work, leading to reduced productivity. In a more long term scenario pneumonia leads children to miss days of school. This, in turn, can lead to them achieving a worse education. This is likely to translate in the long term to lower earnings, stalled career achievement and less productive contributions in the workplace.
If India wishes to scale up provision of the vaccine, it may be better to do so sooner, rather than later. Gavi, a global Vaccine Alliance is currently helping to fund PCV provision until 2021, after which the Indian government will have to bear the full costs. By taking advantage of this now, India may not only save countless thousands of lives, but also be assisting its own economy in the long term.