London School of Hygiene & Tropical Medicine

A safe and 95% effective COVID-19 vaccine with three-year protection against both disease and infection could create £100bns of net value for the UK, according to new research published in The Lancet Infectious Diseases.

The study is the first to model both disease transmission and economic impact in order to provide broad insights about possible future scenarios in a post-vaccination era. It suggests a safe and effective COVID-19 vaccine will save lives, reduce health sector costs and the impact on the national economy by averting physical distancing.

The modelling study was conducted by researchers at the London School of Hygiene & Tropical Medicine (LSHTM) and Public Health England (PHE). It shows that the huge investments that governments have made in research to develop SARS-CoV-2 vaccines have been worthwhile to accelerate the development of vaccine candidates at an unprecedented speed. Key determinants of the value of vaccines were the length of time that people were immune following natural infection, and the price of the vaccine.”

It estimates that even a vaccine that prevents only 50% of symptomatic cases and with short-lived protection for 45 weeks may be worth the cost of development, buying and distributing it, but on its own would not prevent regular large outbreaks.

Ongoing transmission is also expected in an intermediate scenario where vaccines are partially effective against infection, similar to that reported in the phase 3 clinical trials of some of the vaccines used in the UK today.

Professor Mark Jit, study senior author, said: “Models have shown the impact COVID-19 vaccines can have on health. But we know that governments also have to consider economic factors when they make decisions. Our new study looks at the impact of vaccines on health-related quality of life, net health costs and the wider economy.”

The study modelled best-case to worst-case vaccination scenarios, and a range of scenarios for both government-mandated and voluntary physical distancing. Increased physical distancing was assumed to trigger when the number of new COVID-19 cases every day exceeded a certain threshold. The wider economic impact used simple projections of past data on the UK’s gross domestic product (GDP) to estimate the economic health of the UK over 10 years, to provide general insights rather than precise predictions.

The research took a novel approach compared to most other COVID-19 models, by looking beyond only deaths, and accounting for economic impact and the quality of life lost in symptomatic cases, too. In addition, the study also explored the value of physical distancing measures when no vaccine is available (such as the situation in the UK in 2020).

Professor Jit said: “The pandemic has seen vaccines been developed at a rate never seen before. The investment to support these life-saving interventions has been huge. Our results highlight that this expense has been worth it and will benefit the UK, now and in the future.”

Professor Raina MacIntyre of the University of New South Wales, who was not directly involved in the research, commented: “The health and economic burden of living with COVID-19 in the intermediate and worst-case scenarios creates a double disadvantage of high disease burden and high economic cost of ongoing physical distancing measures. While we do not yet know if herd immunity is possible, only the use of high-efficacy vaccines (at least 80–90% against all infection) can possibly achieve it, especially if children can also be vaccinated. Sandmann and colleagues' research provides a rational pathway to aiming for a best-case health and economic scenario.”

Further challenges lie ahead with the rise of new variants of concern that may escape the immune response and vaccines needing to be matched to these emergent variants. The value of vaccines will also depend on other socioeconomic and health-related policies and population behaviours, which underlines the importance of achieving high vaccine uptake in the UK as well as internationally.

The study was partly funded by the UK National Institute for Health Research, the Bill & Melinda Gates Foundation, and the European Union's Horizon 2020 research and innovation programme.

Publication

Frank G Sandmann, Nicholas G Davies, Anna Vassall, W John Edmunds, Mark Jit, on behalf of the Centre for the Mathematical Modelling of Infectious Diseases COVID-19 working group. The potential health and economic value of SARS-CoV-2 vaccination alongside physical distancing in the UK: a transmission model-based future scenario analysis and economic evaluation. Lancet Infectious Diseases. DOI: 10.1016/S1473-3099(21)00079-7