One vaccine to counter many diseases? Modeling the economics of oral polio vaccine against child mortality and COVID-19

Angela Y. Chang, Peter Aaby, Michael S. Avidan, Christine S. Benn, Stefano M. Bertozzi, Lawrence Blatt, Konstantin Chumakov, Shabaana A. Khader, Shyam Kottilil, Madhav Nekkar, Mihai G. Netea, Annie Sparrow, Dean T. Jamison

Research output: Contribution to journalArticlepeer-review


Introduction: Recent reviews summarize evidence that some vaccines have heterologous or non-specific effects (NSE), potentially offering protection against multiple pathogens. Numerous economic evaluations examine vaccines' pathogen-specific effects, but less than a handful focus on NSE. This paper addresses that gap by reporting economic evaluations of the NSE of oral polio vaccine (OPV) against under-five mortality and COVID-19. Materials and methods: We studied 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 incremental to routine immunization. In the latter, a susceptible-exposed-infectious-recovered model was developed to estimate the population benefits of two scenarios, in which OPV would be co-administered alongside COVID-19 vaccines. Incremental cost-effectiveness and benefit-cost ratios were modeled for ranges of intervention effectiveness estimates to supplement the headline numbers and account for heterogeneity and uncertainty. Results: For child mortality, headline cost-effectiveness was $650 per child death averted. For COVID-19, assuming OPV had 20% effectiveness, incremental cost per death averted was $23,000–65,000 if it were administered simultaneously with a COVID-19 vaccine <200 days into a wave of the epidemic. If the COVID-19 vaccine availability were delayed, the cost per averted death would decrease to $2600–6100. Estimated benefit-to-cost ratios vary but are consistently high. Discussion: Economic evaluation suggests the potential of OPV to efficiently reduce child mortality in high mortality environments. Likewise, within a broad range of assumed effect sizes, OPV (or another vaccine with NSE) could play an economically attractive role against COVID-19 in countries facing COVID-19 vaccine delays. Funding: The contribution by DTJ was supported through grants from Trond Mohn Foundation (BFS2019MT02) and Norad (RAF-18/0009) through the Bergen Center for Ethics and Priority Setting.

Original languageEnglish
Article number967920
JournalFrontiers in Public Health
StatePublished - Oct 5 2022


  • COVID-19
  • benefit-cost analyses (BCA)
  • child mortality
  • heterologous (non-specific) effects of vaccines
  • non-specific effects
  • oral polio vaccine (OPV)
  • vaccine effectiveness


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