Distributional Impact Of Rotavirus Vaccination In 25 GAVI Countries: Estimating Disparities In Benefits And Cost Effectiveness

Background: Other studies have demonstrated that the impact and cost effectiveness of rotavirus vacci-nation differs among countries, with greater mortality reduction bene?ts and lower cost-effectiveness ratios in low-income and high-mortality countries. This analysis combines the results of a country level model of rotavirus vaccination published elsewhere with data from Demographic and Health Surveys on within-country patterns of vaccine coverage and diarrhea mortality risk factors to estimate within-country distributional effects of rotavirus vaccination. The study examined 25 countries eligible for funding through the GAVI Alliance.Methods: For each country we estimate the bene?ts and cost-effectiveness of vaccination for each wealth quintile assuming current vaccination patterns and for a scenario where vaccine coverage is equalized to the highest quintile’s coverage. In the case of India, variations in coverage and risk proxies by state were modeled to estimate geographic distributional effects.Results: In all countries, rates of vaccination were highest and risks of mortality were lowest in the top two wealth quintiles. However countries differ greatly in the relative inequities in these two underlying variables. Similarly, in all countries examined, the cost-effectiveness ratio for vaccination ($/Disability-Adjusted Life Year averted, DALY) is substantially greater in the higher quintiles (ranging from 2–10 times higher). In all countries, the greatest potential bene?t of vaccination was in the poorest quintiles. However, due to reduced vaccination coverage, projected bene?ts for these quintiles were often lower. Equitable coverage was estimated to result in an 89% increase in mortality reduction for the poorest quintile and a 38% increase overall.Conclusions: Rotavirus vaccination is most cost-effective in low-income groups and regions. However in many countries, simply adding new vaccines to existing systems targets investments to higher income children, due to disparities in vaccination coverage. Maximizing health bene?ts for the poorest children and value for money require increased attention to these distributional effects