Value of Vaccination Research Network (VoVRN)

Some vaccines appear to have a strong capacity to reduce disease due to pathogens beyond those that are specifically targeted. It is hypothesized that live vaccines may produce increased antibody responses and that measles vaccination may preserve immune memory by preventing measles-induced immune deletion. However, more biological evidence is needed to confirm the existence of any off-target effects and to support the incorporation of the resulting benefits into formal vaccine assessments.

Active projects:

ELUCIDATING THE EXTRA DIVIDENDS OF VACCINATION

This study will examine the biological basis for improved survival from non-vaccine pathogens following measles vaccination. Researchers will quantify and map the entire range of antibodies in paired sets of clinical serum samples collected before and after (1) natural measles infections or (2) vaccination. By coupling this data with detailed ecological models of measles and non-measles infectious-disease mortality across populations and over multiple decades spanning the introductions of measles vaccines, the study team will formally quantify the broad benefits of measles vaccination on childhood health, and the associated long-term labor-market gains.

• Stephen Elledge, PhD (Principal Investigator, Brigham and Women’s Hospital; Harvard Medical School)

• Michael Mina, MD, PhD (Lead Investigator, Harvard T.H. Chan School of Public Health; Brigham and Women’s Hospital)

Antimicrobial resistance (AMR) refers to a pathogen’s ability to resist the effects of antimicrobial drugs, such as antibiotics. AMR is one of the greatest health challenges facing the world today. Each year, an estimated 700,000 people die globally as a result of drug-resistant infections. Thankfully, vaccines may be an effective tool for reducing the burden of antimicrobial resistance. Vaccination plausibly combats antimicrobial resistance in a number of ways. One way is by directly reducing the threat of infection by drug-resistant pathogens. Another, is by reducing the overall incidence of disease, thereby contributing to a general decrease in antimicrobial drug use. As new vaccines are developed and access to existing vaccines improves, vaccination is poised to play a powerful role in reducing the use and misuse of antimicrobials and helping slow the proliferation of AMR.

Active projects:

THE EFFECTS OF VACCINE INTRODUCTION ON HEALTH, WELLBEING, ANTIMICROBIAL CONSUMPTION AND RESISTANCE

This study aims to quantify the magnitude of reduced antimicrobial consumption resulting from the introduction of new vaccines in India. Researchers will study the effects of differentially timed vaccine introductions across India on (1) respiratory and diarrheal diseases — particularly rotavirus, Haemophilus influenzae type b, and pneumococcal disease — and (2) antimicrobial use and resistance. Researchers will measure the number of incident cases, deaths, disability‐adjusted life years, out‐of‐pocket treatment expenditure, and use of antimicrobials and associated costs that would be averted by scale‐up of these vaccines in India.

• Ramanan Laxminarayan (Principal Investigator, Center for Disease Dynamics, Economics & Policy)

• Arindam Nandi (Lead Investigator, Center for Disease Dynamics, Economics & Policy)

There is evidence that interventions such as infant and childhood vaccination lead to improved cognitive development and educational attainment. Immunization prevents ill health due to infections, and immunization programs facilitate access to other preventative healthcare and nutritional services during regularly scheduled visits to healthcare facilities. Maternal immunization prevents disease and adverse outcomes among pregnant women and their young infants during a period of substantial neurological development. VoVRN investigators in this research area focus on measuring and monetizing immunization benefits with respect to cognitive development and educational outcomes.

Active projects:

VACCINE IMPACT ON COGNITION AND SCHOOLING: A PILOT IN INDIA

This quasi-experimental study evaluates the impact of immunization on early cognitive development and educational attainment – by comparing children in PCV-rollout districts to children in adjacent comparison districts. The research team will assess the viability of enrolling children (ages 12-18 months and 24-30 months) from the Mewat district in Haryana India, obtaining valid health and school records, performing cognitive assessments, and retaining children and caregivers for continued study. Researchers will track physical growth, health outcomes (e.g., hospitalizations and clinic visits), educational outcomes (e.g., school enrollment, rate of dropout, and absenteeism), and survey caregivers about their perception regarding the value of vaccination (health, economic benefits) and their experiences with immunization clinic visits.

• Anita Shet, MD, PhD (Principal Investigator, Johns Hopkins Bloomberg School of Public Health)

THE BROADER IMPACT OF MATERNAL IMMUNIZATION IN SUB-SAHARAN AFRICA AND ASIA: A MULTISITE STUDY IN RANDOMIZED CLINICAL CONTROL TRIAL COHORTS

This study assesses the broad benefits of maternal immunization in South Africa and Bangladesh. Using established cohorts from randomized clinical controlled trials of maternal influenza immunization, researchers will estimate the association between maternal immunization status and productivity gains related to cognitive outcomes (measured through standardized test scores) and educational outcomes (measured through school attainment and/or enrollment). This study will be the first to assess the impact of maternal immunization on educational and cognitive outcomes across multiple sites and age groups. The high-quality data from this study will inform evidence-based decision making with respect to global maternal vaccination policy and investment strategies for influenza and other maternal vaccine targets.

• Saad Omer, MBBS, MPH, PhD (Principal Investigator, Yale University)

A key challenge with research that aims to assess and quantify the broad value of vaccination is summarizing the myriad, complex health and socio-economic benefits of vaccination and translating the evidence into readily accessible and actionable forms such as benefit-cost ratios and social rates of return on investment. Research in this thematic area uses modeling to deliver to health and economic policymakers rigorous evidence on the full social and economic benefits of different vaccines.

Active projects:

DEVELOPMENT AND APPLICATION OF A COMPREHENSIVE MODEL FOR THE FULL SOCIAL AND ECONOMIC BENEFITS OF VACCINES

In this project, researchers will develop a model to estimate the full social and economic benefits of a specific vaccine, or package of vaccines, for a given context. Once developed, the model will be applied to a specific country setting. Countries of primary interest for early application of the model are those that have recently transitioned from Gavi support and those that will do so in the coming years and need to make difficult decisions concerning which immunization programs to fund independently. The project researchers will also apply the model to representative Gavi-supported countries in order to help Gavi and other international donors rationally assess which new vaccinations are likely to provide the greatest returns on investment. This project will also create an easy-to-use software program that will enable policymakers and others to apply the model to different vaccines and country contexts.

• J.P. Sevilla, JD, PhD (Principal Investigator, Harvard T.H. Chan School of Public Health)

• David Bloom, PhD (Principal Investigator, Harvard T.H. Chan School of Public Health)