The Broader Value of Existing Vaccines in the Fight Against COVID-19: Beware of Tunnel Vision

Article by: Lotte Steuten, Eleanor Bell & Margherita Neri

 

The COVID-19 pandemic painfully reveals the broad and disastrous health, economic and societal impact of a highly infectious and potentially deadly disease for which there is, as yet, no vaccine.

In addition to the human suffering caused to individuals diagnosed with COVID-19, there is also a large negative impact on their family members, friends, and larger social environment, on healthcare workers, and on the healthcare system’s capacity. And then there is the devastating economic impact, crippling economies worldwide. As of Sept 2020, 30.6 million COVID-19 cases and 950,000 COVID-19 deaths have been reported to the World Health Organisation (WHO) (COVID-19 Dashboard, 2020; WHO, 2020); the number of indirect deaths due to pressure on health systems are harder to estimate, but may be equally devastating (Roberton et al., 2020). In the US alone, the direct costs of treating COVID-19 are estimated to total more than $160 billion (Bartsch et al., 2020). The broader economic implication, as estimated by the World Bank, is a 5.2% contraction in global GDP in 2020. This is the deepest global recession in post-war history, despite the extraordinary efforts of governments to counter the downturn with fiscal and monetary policy support (World Bank, 2020).

A vaccine that would effectively prevent this disease will, therefore, have a broad value to society – value that extends well beyond preserving the health of the vaccinated individual and avoiding the costs associated with COVID-19 disease.

These broader value aspects are by no means unique to a potential COVID-19 vaccine, but have long been recognised by health economists as important value attributes of many existing vaccines (Jit et al., 2015; Bloom, 2017; Hernandez-Villafuerte et al., 2020; Brassel et al., 2020a). Within the healthcare system for example, vaccines are important enablers of other healthcare interventions. They can prevent seasonal outbreaks of infections, thereby alleviating pressure on healthcare services and facilitating better care for other patients (Standaert and Rappuoli, 2017). The expansion of the flu vaccination programme in the UK, for example, is done with the view that an existing vaccine will have a broader impact on other parts of the health system by relieving the winter pressures on acute and emergency care, and ready their National Health Service for the risk of a second peak of coronavirus cases (GOV.UK, 2020)

Vaccines can also have macroeconomic effects extending beyond the healthcare system, not only by preventing pandemics and outbreaks of emerging diseases, but because they can increase the lifetime productivity of vaccinated individuals (Jit et al., 2015; Bärnighausen et al., 2014; Brassel, et al., 2020b). These are just two examples of the broader value attributes of vaccines which have been identified and evidenced by researchers. OHE has developed a framework which consolidates the existing research into a Vaccines Value Framework.   

Today, as the world is figuring out how to deal with COVID-19, it is worth taking stock of the broader value that existing vaccines bring to societies suffering from this pandemic.

These broader value aspects can be illustrated by looking for example at vaccines against pneumococcal disease or influenza. As the coronavirus responsible for COVID-19 causes respiratory disease (Salehi et al., 2020), and some of those infected go on to develop other conditions like pneumonia (Zhao et al., 2020), the broader value of current vaccines establishes itself in at least three ways, as shown below:

Figure: mechanism by which existing vaccines may provide broad value helping to relieve the burden on healthcare systems during the COVID-19 pandemic

Protecting people without COVID-19 from other respiratory infections

While no existing vaccines protect against COVID-19, there are various vaccines available that, for example, prevent vaccine-type pneumococcal community-acquired pneumonia (CAP). Management of CAP places a considerable burden on healthcare resources:

  • patients hospitalised for CAP spend on average 12 days there
  • 14% will be admitted to the ICU for 9 days on average, and
  • 14% will require mechanical ventilation (Ostermann, 2014).

From these data it follows that by helping to prevent vaccine-type pneumococcal CAP hospitalisations, the healthcare system burden may be reduced, which would subsequently allow hospital resources to be directed to more needy patients, potentially saving additional lives.

Furthermore, a statistical modelling study suggested that receipt of pneumococcal and influenza vaccines might be associated with a lower risk of COVID-19 infections (Jehi et al., 2020), stipulating this is not a causal effect and other factors likely contribute to this finding too. However, if confirmed in further research, this would indicate that existing vaccinations may further help to avoid COVID-19 morbidity and the overburdening of healthcare systems. 

Preventing other respiratory infections in COVID-19 patients

Amongst COVID-19 patients, existing vaccines can decrease mortality by helping to prevent those patients contracting other infections in addition to COVID-19. Pneumonia or seasonal influenza for example, due to their effects on lung inflammation, might increase the risk for a COVID-19 patient to develop more severe symptoms than they otherwise would (Thindwa et al., 2020). Therefore, the authors of this study suggest that “where already in routine use among older adults and/or adults at-risk, maintaining both seasonal influenza and pneumococcal polysaccharide vaccination at high coverage has the potential to not only reduce the burden of the targeted diseases but also prevent a proportion of COVID-19 morbidity and mortality, if they can be delivered while minimising the risk for SARS-CoV-2 transmission” (Thindwa et al., 2020).

In summary, while the world eagerly awaits an effective COVID-19 vaccine, these extraordinary times more than ever illuminate the broader value of the vaccines we already have. As these broader values are not, or only partly, considered in health technology assessment (Bloom et al., 2017; Hernandez-Villafuerte et al., 2020; Brassel et al., 2020a), vaccines (like other interventions that have substantial broader value) are systematically undervalued. Such undervaluation can lead to underutilisation (Bloom et al., 2018), leaving our health systems and societies more vulnerable than they need to be. The time for multi-stakeholder action to recognise and reward the broader value of vaccines and other healthcare interventions is now (Brassel et al. 2020a; Brassel et al., 2020b)

Funding Acknowledgement:

OHE has received a Sponsorship from Pfizer for developing this blog and received Pfizer’s input on its content. OHE retained right of approval over all content related to the blog.

References:

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Bartsch, S.M., Ferguson, M.C., McKinnell, J.A., et al., 2020. The Potential Health Care Costs And Resource Use Associated With COVID-19 In The United States: A simulation estimate of the direct medical costs and health care resource use associated with COVID-19 infections in the United States. Health Affairs, 39(6), pp.927–935. 10.1377/hlthaff.2020.00426.

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Related Research

Brassel S., Neri M., O’Neill P. and Steuten L., 2020a. Realising the broader value of vaccines in the UK. OHE Consulting Report, London: Office of Health Economics. Available at: https://www.ohe.org/publications/realising-broader-value-vaccines-uk

Brassel S. and Steuten L., 2020. The broader value of vaccines - The return on investment from a gov-ernmental perspective. OHE Consulting Report, London: Office of Health Economics. Available at: https://www.ohe.org/publications/broader-value-vaccines-return-investment-governmental-perspective

Hernandez-Villafuerte, K., Shah, K., Herdman, M and Lorgelly, P. (2018). Meningococcal Vaccines: An International Comparison of Decision Making Processes, Frameworks and Methodologies. Are Values Missing? OHE Consulting Report, London: Office of Health Economics. Available at: https://www.ohe.org/publications/meningococcal-vaccines-international-comparison-decisionmaking-processes-frameworks

Berdud, M., Towse, A., Jofre-Bonet, M., 2020. The Economics of Innovation in Times of Pandemic: How to Incentivise the Development, Supply, and Continuous Improvement of Innovative Solutions to Fight COVID-19? ? OHE Commentary, London: Office of Health Economics. Available at: https://www.ohe.org/news/economics-innovation-times-pandemic-how-incentivise-development-supply-and-continuous

Towse, A. Firth, I. (2020) How should the world pay for a COVID-19 vaccine? Draft paper to accompany the 2020 OHE Annual Lecture. Office of Health Economics. Available: https://www.ohe.org/publications/%E2%80%9Chow-should-world-pay-covid-19-vaccine%E2%80%9D-draftlecture-paper

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