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The impact of alternative delivery strategies for novel tuberculosis vaccines in low-income and middle-income countries: a modelling study

Clark, Rebecca A; Mukandavire, Christinah; Portnoy, Allison; Weerasuriya, Chathika K; Deol, Arminder; Scarponi, Danny; Iskauskas, Andrew; Bakker, Roel; Quaife, Matthew; Malhotra, Shelly; Gebreselassie, Nebiat; Zignol, Matteo; Hutubessy, Raymond C W; Giersing, Birgitte; Jit, Mark; Harris, Rebecca C; Menzies, Nicolas A; White, Richard G

The impact of alternative delivery strategies for novel tuberculosis vaccines in low-income and middle-income countries: a modelling study Thumbnail


Authors

Rebecca A Clark

Christinah Mukandavire

Allison Portnoy

Chathika K Weerasuriya

Arminder Deol

Danny Scarponi

Roel Bakker

Matthew Quaife

Shelly Malhotra

Nebiat Gebreselassie

Matteo Zignol

Raymond C W Hutubessy

Birgitte Giersing

Mark Jit

Rebecca C Harris

Nicolas A Menzies

Richard G White



Abstract

Background
Tuberculosis is a leading infectious cause of death worldwide. Novel vaccines will be required to reach global targets and reverse setbacks resulting from the COVID-19 pandemic. We estimated the impact of novel tuberculosis vaccines in low-income and middle-income countries (LMICs) in several delivery scenarios.
Methods
We calibrated a tuberculosis model to 105 LMICs (accounting for 93% of global incidence). Vaccine scenarios were implemented as the base-case (routine vaccination of those aged 9 years and one-off vaccination for those aged 10 years and older, with country-specific introduction between 2028 and 2047, and 5-year scale-up to target coverage); accelerated scale-up similar to the base-case, but with all countries introducing vaccines in 2025, with instant scale-up; and routine-only (similar to the base-case, but including routine vaccination only). Vaccines were assumed to protect against disease for 10 years, with 50% efficacy.
Findings
The base-case scenario would prevent 44·0 million (95% uncertainty range 37·2–51·6) tuberculosis cases and 5·0 million (4·6–5·4) tuberculosis deaths before 2050, compared with equivalent estimates of cases and deaths that would be predicted to occur before 2050 with no new vaccine introduction (the baseline scenario). The accelerated scale-up scenario would prevent 65·5 million (55·6–76·0) cases and 7·9 million (7·3–8·5) deaths before 2050, relative to baseline. The routine-only scenario would prevent 8·8 million (95% uncertainty range 7·6–10·1) cases and 1·1 million (0·9–1·2) deaths before 2050, relative to baseline.
Interpretation
Our results suggest novel tuberculosis vaccines could have substantial impact, which will vary depending on delivery strategy. Including a one-off vaccination campaign will be crucial for rapid impact. Accelerated introduction—at a pace similar to that seen for COVID-19 vaccines—would increase the number of lives saved before 2050 by around 60%. Investment is required to support vaccine development, manufacturing, prompt introduction, and scale-up.

Citation

Clark, R. A., Mukandavire, C., Portnoy, A., Weerasuriya, C. K., Deol, A., Scarponi, D., …White, R. G. (2023). The impact of alternative delivery strategies for novel tuberculosis vaccines in low-income and middle-income countries: a modelling study. The Lancet Global Health, 11(4), 546-555. https://doi.org/10.1016/s2214-109x%2823%2900045-1

Journal Article Type Article
Acceptance Date Mar 1, 2023
Publication Date 2023-04
Deposit Date Oct 31, 2023
Publicly Available Date Oct 31, 2023
Journal The Lancet Global Health
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 11
Issue 4
Pages 546-555
DOI https://doi.org/10.1016/s2214-109x%2823%2900045-1
Public URL https://durham-repository.worktribe.com/output/1872776

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Licence
http://creativecommons.org/licenses/by/3.0/

Publisher Licence URL
http://creativecommons.org/licenses/by/3.0/

Copyright Statement
This is an Open Access article published under the
CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any
specific organisation, products, or services. The use of the WHO logo is not permitted. This notice should be preserved
along with the article’s original URL





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