Estimated public health impact of human rotavirus vaccine (HRV) and pneumococcal polysaccharide protein D-conjugate vaccine (PHiD-CV) on child morbidity and mortality in Gavi-supported countries

ABSTRACT

Vaccine impact models against rotavirus disease (RD) and pneumococcal disease (PD) in low- and middle-income countries assume vaccine coverage based on other vaccines. We propose to assess the impact on severe disease cases and deaths avoided based on vaccine doses delivered by one manufacturer to Gavi-supported countries. From the number of human rotavirus vaccine (HRV) and pneumococcal polysaccharide protein D-conjugate vaccine (PHiD-CV) doses delivered, we estimated the averted burden of disease 1) in a specific year and 2) for all children vaccinated during the study period followed-up until 5 years (y) of age. Uncertainty of the estimated impact was assessed in a probabilistic sensitivity analysis using Monte-Carlo simulations to provide 95% confidence intervals. From 2009 to 2019, approximately 143 million children received HRV in 57 Gavi-supported countries, avoiding an estimated 18.7 million severe RD cases and 153,000, deaths. From 2011 to 2019, approximately 146 million children received PHiD-CV in 36 countries, avoiding an estimated 5.0 million severe PD cases and 587,000 deaths. The number of severe cases and deaths averted for all children vaccinated during the study period until 5 years of age were about 23.2 million and 190,000, respectively, for HRV, and 6.6 million and 749,000, respectively, for PHiD-CV. Models based on doses delivered help to assess the impact of vaccination, plan vaccination programs and understand public health benefits. In 2019, HRV and PHiD-CV doses delivered over a 5-y period may have, on average, averted nine severe disease cases every minute and one child death every 4 min.

Plain Language Summary

What is the context?

• The WHO added the pneumococcal conjugate vaccine and the rotavirus vaccine in the recommended vaccination schedule of all countries in 2007 and 2009, respectively.

• Previous studies estimated the public health benefit of these vaccines by approximating the number of children who received them.

What is new?

• We used an alternative approach to estimate the benefit based on actual number of doses of the vaccines, human rotavirus vaccine (HRV; Rotarix) and pneumococcal polysaccharide protein D-conjugate vaccine (PHiD-CV; Synflorix) delivered to each country considered.

• The study analyzed data from children under 5 years of age in 60 Gavi-supported countries by identifying the number of vaccine doses delivered, estimating the number of children fully covered, applying the country-specific disease epidemiology, estimating the number of severe disease cases and deaths avoided.

• From 2009 to 2019, approximately 143 million children were vaccinated with HRV avoiding an estimated 18.7 million severe rotavirus disease cases and 153,000 deaths.

• From 2011 to 2019, about 146 million children were vaccinated with pneumococcal vaccine avoiding an estimated 5.0 million severe pneumococcal disease cases and 587,000 deaths.

What is the impact?

• The benefit of HRV and PHiD-CV in Gavi-supported countries is often estimated based on assumptions of vaccine coverage rates.

• A modeling approach based on doses delivered by the vaccine manufacturer can provide an additional view on the potential vaccine benefits and improve planning, contribution, and sustainability of the immunization programs at a country level.

• In 2019, HRV and PHiD-CV together averted nine cases of severe disease each minute and one child death every 4 minutes.

Graphical Abstract

KEYWORDS:

• Rotavirus
• pneumococcal disease
• rotavirus vaccine
• pneumococcal vaccine
• Gavi
• doses delivered

Highlights

• Vaccine benefit is often estimated on assumptions of vaccine coverage

• Another approach is to use the number of vaccine doses supplied by manufacturers

• This provides a simple method to ascertain gaps in planning and implementation

• HRV averted an estimated 18 million severe RD cases and 150,000 deaths (2009−2019)

• PHiD-CV averted estimated 5 million severe PD cases and 600,000 deaths (2011−2019)

• HRV and PHiD-CV together averted 9 severe cases/min and 1 death every 4 min (2019)

Article in a tweet

Vaccine impact against rotavirus disease and pneumococcal disease is estimated in low- and middle-income countries with an approach based on vaccine doses delivered through manufacturers, GAVI and UNICEF, by which the impact on severe disease cases and deaths avoided was assessed.

Acknowledgments

The authors would like to thank Tathyana Giannotti Cousseau for her input regarding the initiation, collection of the actual sales volume per year and assessment of various methodologies adopted by Supranational agencies like Gavi and John Hopkins for “Lives Saved” model. The authors would also like to thank Business & Decision Life Sciences platform for editorial assistance and manuscript coordination, on behalf of GSK, and TVF communications platform for the design support for the digital illustration, on behalf of GSK. Mary Greenacre (An Sgriobhadair Ltd) provided writing support for this literature review.

Disclosure statement

AM, DVO, LS, MO, PI, PP, and SM are employed by/hold shares in GSK. BS was employed by and held shares in GSK at the moment of the study. All authors declare no other financial or non-financial relationships or activities that could have influenced professional judgment.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website at https://doi.org/10.1080/21645515.2022.2135916

Additional information

Trademark

Rotarix and Synflorix are trademarks owned by or licensed to GSK.

Contributorship

AM, BS, DVO, LS, MO, PI, PP and SM were involved in the design of the study. AM, BS, PI, PP and SM collected or generated the data. All authors analyzed and/or interpreted the data and participated to the development of this manuscript and in its critical review with important intellectual contributions. All authors had full access to the data and gave approval of the final manuscript before submission. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The work described was carried out in accordance with ICMJE recommendations for conduct, reporting, editing and publications publishing of scholarly work in medical journals. The corresponding author had the final responsibility to submit for publication.

Statements of ethical approval

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Additional information

Funding

GlaxoSmithKline Biologicals SA funded this study and was involved in all stages of study conduct, including analysis of the data. GlaxoSmithKline Biologicals SA also paid all costs associated with the development and publication of this manuscript.