Lessons from Cost-Effectiveness of HIV vaccines for COVID Vaccines

Will HIV vaccines compete with existing HIV prevention strategies? Who is doing COVID vaccine cost-effectiveness analysis?

Fred Hutch Science Spotlight translated the math in our peer-reviewed paper published in the Journal of the International AIDS Society to explain the economic tradeoffs of delivering an HIV vaccine in Seattle in the future.

Our prior review of published HIV vaccine cost-effectiveness concluded that most assessments of the added value of a vaccine were imagined in the context of a world without pre-exposure prophylaxis (PrEP). That is no longer the case.

The number of available options for effective HIV prevention is expected to grow in the near future with long-acting injectable PrEP and multi-dose HIV vaccines in the last stages of testing. Of public-health importance is the net increase of the overall population proportion using HIV prevention following the approval of new products instead of replacement of existing prevention methods.
EXPERT MATHEMATICIAN DOBROMIR DIMITROV

We chose to focus on Seattle of all places because it is a national leader in the implementation of novel HIV prevention strategies and it’s a global hub for vaccine research (thank you Bill Gates and NIH). The core operating center for the National Institute of Allergy and Infectious Diseases (NIAID) HIV Vaccine Trials Network (HVTN) is also based there, the headquarters for coordinating protocols and clinical trial sites testing vaccines around the world.

Most recently, HVTN was adapted by the US National Institutes of Health to form the NIAID COVID-19 Prevention Network (CoVPN) in respond to the global pandemic. This was a smart move by NIH and NIAID to leverage decades of HIV vaccine trial experience on-the-ground to jump-start the evaluation of COVID vaccine candidates. Surprising no one, HVTN investigators were among the first to invent and develop new COVID vaccines – like this one in Nature from Dan Barouch** at Harvard.

In the near-future, I’m looking forward to reviewing cost-effectiveness analyses of COVID vaccines. You can bet I’m looking out for a good dynamic transmission model that captures the spillover benefits of herd immunity and at the same time includes the indirect costs of vaccination from a societal perspective.

Until then, who is working on COVID vaccine cost-effectiveness analysis? I really hope that you academic enough to have no major conflicts of interest that could bias the predicted value-based price per dose. I hope that you are sufficiently resourced to build a rigorous, transparent, reproducible, defensible, differential equation-based, dynamic transmission model. I hope that you synthesize all existing evidence and have access to real world data to calibrate and validate your model. Best wishes. We need you.

** Regarding Dan Barouch: he is a brilliant prodigy, hero in immunology and one time circa ~2008 I taught him how to put his blackberry on silent because he could not figure out how for months since purchasing the device. Some people have street skills and some people have neutralizing antibody magic skills.

Acknowledgements

This research was a collaboration between the HIV Vaccine Trials Network (HVTN), Virology and Infectious Diseases Division at Fred Hutch, and The CHOICE Institute at the University of Washington. The work was supported by generous resources from the Agency for Healthcare Research and Quality (AHRQ), the American Foundation for Pharmaceutical Education (AFPE), the University of Washington Center for AIDS Research (CFAR), and the National Institutes of Health (NIH).

Image credits to hvtn.org and coronaviruspreventionnetwork.org