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Updated: May 7, 2026
Experimental Human Pneumococcal Carriage
Published on: February 15, 2013
Cost effectiveness of child pneumococcal conjugate vaccination in middle-income countries
Mari M Nakamura1, Azadeh Tasslimi, Tracy A Lieu
1Division of Infectious Diseases, Department of Medicine and Information Services Department, Children's Hospital Boston, 300 Longwood Avenue, Enders 7, Boston, MA 02115, USA.
Insights
Pneumococcal conjugate vaccines prevent millions of pneumonia and invasive disease cases and deaths in children under-5 in middle-income countries. Vaccination is cost-effective, with a compelling economic case for widespread adoption.
Area of Science:
- Public Health
- Vaccinology
- Health Economics
Background:
- Policy-makers need data on the benefits and economic viability of pneumococcal conjugate vaccination (PCV) in middle-income nations.
- Pneumococcal disease remains a significant public health challenge in these regions, particularly for young children.
Purpose of the Study:
- To evaluate the impact and cost-effectiveness of 7-, 10-, and 13-valent PCVs in 77 middle-income countries.
- To assess direct and herd protection benefits, including serotype replacement, over a 10-year period.
Main Methods:
- Development of decision analysis models comparing PCV strategies against no vaccination.
- Inclusion of direct protection for vaccinated infants and indirect (herd) protection for unvaccinated individuals.
- Calculation of averted cases, deaths, and disability-adjusted life-years (DALYs), alongside cost-effectiveness analysis.
Main Results:
- PCV is projected to prevent over 11.0 million cases and 314,000 deaths in children under-5 within 10 years.
- Herd protection is estimated to prevent an additional 3.1 million cases and 163,000 deaths in older populations.
- Vaccination is cost-effective for most countries, with the 10- and 13-valent vaccines being effective for all 77 nations studied.
Conclusions:
- Pneumococcal conjugate vaccination presents a strong economic case for middle-income countries.
- Widespread PCV implementation offers substantial public health benefits, significantly reducing disease burden and mortality.
- The 10- and 13-valent vaccines demonstrate particular value, justifying their adoption across diverse middle-income settings.
Abstract:
Policy-makers require information on the potential benefits of and economic case for pneumococcal conjugate vaccination in middle-income countries. We built decision analysis models to evaluate a three-dose infant series of the 7-, 10- or 13-valent pneumococcal conjugate vaccines in 77 middle-income countries compared with no vaccination, accounting for direct protection of vaccinated children as well as herd protection and serotype replacement in unvaccinated children and adults. Over 10 years, pneumococcal vaccination would prevent at least 11.0 million cases and 314 000 deaths in children under-5, one-third of the pneumonia and invasive disease cases and deaths that would occur in this age group without vaccination. Herd protection would prevent 3.1 million cases and 163 000 deaths in older children and adults. A total of 11.1 million discounted disability-adjusted life-years (DALY) would be averted. At a dose cost of $10 for lower- middle-income and $20 for upper-middle-income countries, the net pooled (for all countries together) discounted vaccination cost would be $18.1 billion ($1600 per DALY averted). Vaccination would be cost effective for 72 countries with the 7-valent vaccine and for all countries with the 10- or 13-valent vaccines. The economic case for vaccination is compelling for middle-income countries.
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