The Indian Government is currently rolling out a pneumococcal conjugate vaccine (PCV) across the country to tackle the disease, which claimed the lives of an estimated 105,000 children under the age of five in 2010.

However, the vaccine is significantly more expensive than others included in India’s Universal Immunisation Programme. In addition, its effectiveness in low and middle-income countries is uncertain.

The Global Alliance for Vaccines and Immunization is currently helping to fund PCV provision until 2021, after which the Indian Government will have to bear the full costs.

To predict the potential outcome and cost-effectiveness of India’s PCV programme, researchers at the University of Strathclyde in the UK and the Center for Disease Dynamics Economics and Policy in the US and in New Delhi, India used a model they had previously developed and validated called IndiaSim, which is representative of the Indian population and health system.

The analysis considered the distribution of the dominant strains of the disease in India and the characteristics and behaviour of the host population within the country’s health system.

The study, published in the journal BMJ Global Health, concludes the programme could prevent 34,800 under-five deaths, cost $240m (1,600 crore rupees) and save families $48.7 million in treatment costs annually.

This outcome assumed vaccination coverage levels similar to those achieved by the diphtheria, pertussis and tetanus (DPT) immunisation programme; approximately 77 per cent.

Increasing the coverage level to 90 per cent was found to be the most cost-effective outcome in over 95 per cent of simulated outcomes.

Lead author Dr Itamar Megiddo, Assistant Professor and Chancellor’s Fellow in Strathclyde Business School, said: “Pneumonia is a major cause of death in India and as many other countries have done the government decided to introduce PCV in its vaccination programme.

“However, PCV is expensive and its efficacy is uncertain for a number of reasons. These include a lack of information on the distribution of the disease-causing strains in India and lack of contextualized information on the efficacy of the vaccine in India and other low- and middle-income countries.

“The affordability and cost effectiveness for a country like India is especially important. Although our study had limitations, and there are data gaps that need to be filled, even with conservative assumptions we believe the vaccination would avert a significant number of deaths.

“It would also protect some of the poorest people in India from potentially catastrophic expenditure and deliver value for money. We would recommend the Indian Government includes PCV vaccination in the Universal Immunisation Programme, and the vaccine’s effectiveness should be continuously monitored as it is rolled out to provide more data to inform vaccination strategy.”

The study was funded by the Bill & Melinda Gates Foundation through the Global Antibiotic Resistance Partnership and supported by Princeton University through its Grand Challenges Program.



University of Strathclyde

Center for Disease Dynamics, Economics & Policy