Background: Recent reviews summarize evidence that some vaccines have heterologous or non-pathogen specific effects (NSE) against multiple pathogens. Numerous economic evaluations examine vaccines’ pathogen-specific effects, but only two economic evaluations of NSE exist. This paper starts to fill this gap by conducting economic evaluations of the NSE of oral polio vaccine (OPV) against under-five mortality and COVID-19.
Methods: We conducted economic evaluations in two settings: (1) reducing child mortality in a high-mortality setting (Guinea-Bissau) and (2) preventing COVID-19 in India. In the former, the intervention involves three annual campaigns in which children receive OPV. In the latter, a susceptible-exposed-infectious-recovered model was developed to estimate the population benefits of two realistic vaccine scenarios, in which OPV would be co-administered alongside COVID-19 vaccines. Incremental cost-effectiveness and benefit-cost ratios were estimated for broad ranges of intervention effectiveness estimates to supplement the headline numbers and account for uncertainty.
Findings: For child mortality, headline cost-effectiveness was $650 per child death averted. For COVID-19, assuming OPV has 20% effectiveness, incremental cost per death averted was $23,000-65,000 when it was administered simultaneously with a COVID-19 vaccine less than 200 days into a wave of the epidemic. If OPV can be available earlier, the cost per averted death falls to $2600-6100, Estimated benefit-to-cost ratios vary but are consistently high.
Interpretation: Economic evaluation suggests large potential of LAVs, such as OPV, to reduce child mortality in high mortality environments. Likewise, within a broad range of assumed effect sizes LAVs could play an economically attractive role against COVID-19.