Beyond cost-effectiveness: Using systems analysis for infectious disease preparedness

Area of Science:

• Global Health
• Health Policy
• Vaccine Development

Background:

• Ebola vaccines were historically low priority due to cost-effectiveness and profitability concerns.
• Recent outbreaks dramatically shifted priorities for Ebola vaccines among international health agencies.
• Traditional analyses failed to capture crucial real-world decision-making factors.

Purpose of the Study:

• To demonstrate the utility of multi-criteria systems analysis for evaluating and prioritizing vaccine development.
• To highlight limitations of cost-effectiveness and cost-benefit analyses in complex health scenarios.
• To show how systems analysis can incorporate broader societal impacts often missed by traditional methods.

Main Methods:

• Utilized Multi-Criteria Systems Analysis (MCSA).
• Employed the SMART Vaccines framework to visualize and include "other factors" in decision-making.
• Compared MCSA with traditional cost-effectiveness and cost-benefit analyses.

Main Results:

• Standard analyses overlooked critical factors like inequality, disparity, and indirect effects on uninfected populations.
• MCSA effectively incorporates diverse criteria, including social, economic, and public health considerations.
• The SMART Vaccines approach demonstrated a more comprehensive evaluation of vaccine development priorities.

Conclusions:

• Multi-criteria systems analysis provides a more robust framework for health policy and investment decisions than traditional methods.
• Systems analysis is essential for addressing complex global health threats like Ebola and Zika, considering issues of equity and disparity.
• Adopting systems analysis can lead to more informed and beneficial priority-setting processes for vaccine development and other health initiatives.