February 3, 2007
ectiveness o± pneumococcal conjugate vaccination
in the prevention o± child mortality: an international
Anushua Sinha, Orin Levine, Maria D Knoll, Farzana Muhib, Tracy A Lieu
Routine vaccination of infants against
(pneumococcus) needs substantial
investment by governments and charitable organisations. Policymakers need information about the projected health
ts, costs, and cost-e±
ectiveness of vaccination when considering these investments. Our aim was to incorporate
these data into an economic analysis of pneumococcal vaccination of infants in countries eligible for F
from the Global Alliance for Vaccines & Immunization (GAVI).
We constructed a decision analysis model to compare pneumococcal vaccination of infants aged 6, 10, and
14 weeks with no vaccination in the 72 countries that were eligible as of 2005. We used published and unpublished
data to estimate child mortality, e±
ectiveness of pneumococcal conjugate vaccine, and immunisation rates.
Pneumococcal vaccination at the rate of diptheria–tetanus–pertussis vaccine coverage was projected to prevent
262 000 deaths per year (7%) in children aged 3–29 months in the 72 developing countries studied, thus averting
8·34 million disability-adjusted life years (DALYs) yearly. If every child could be reached, up to 407 000 deaths per year
would be prevented. At a vaccine cost of International $5 per dose, vaccination would have a net cost of $838 million, a
cost of $100 per DALY averted. Vaccination at this price was projected to be highly cost-e±
ective in 68 of 72 countries
when each country’s per head gross domestic product per DALY averted was used as a benchmark.
At a vaccine cost of between $1 and $5 per dose, purchase and accelerated uptake of pneumococcal vaccine
in the world’s poorest countries is projected to substantially reduce childhood mortality and to be highly cost-e±
Vaccination of infants in the world’s poorest countries
the potential to prevent many deaths, but would need
substantial funding. Pneumonia and other respiratory
infections cause about 2 million child deaths yearly,
nearly all in developing countries.
deaths are believed to be due to bacterial pneumonia,
is the most common cause of bacterial
pneumonia in infants and young children.
pneumococcus often causes otitis media, bacteraemia,
sepsis, and meningitis in early childhood. Experience
with other vaccines suggests that, without substantial
global investment and coordinated eF
ort, a conjugated
pneumococcal vaccine is unlikely to reach children in
developing countries during the next decade.