Economic impact of vaccine safety incident in Ukraine: The economic case for safety system investment

Haley Budigan Ni; Gatien de Broucker; Bryan N Patenaude; Matthew Z Dudley; Lee M Hampton; Daniel A Salmon

doi:10.1016/j.vaccine.2022.11.004

Economic impact of vaccine safety incident in Ukraine: The economic case for safety system investment

Vaccine. 2023 Jan 4;41(1):219-225. doi: 10.1016/j.vaccine.2022.11.004. Epub 2022 Nov 24.

Authors

Haley Budigan Ni¹, Gatien de Broucker², Bryan N Patenaude², Matthew Z Dudley³, Lee M Hampton⁴, Daniel A Salmon⁵

Affiliations

¹ Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Office of Health Equity, California Department of Public Health, 850 Marina Bay Pkwy, Unit F175, Richmond, CA 94804, USA.
² Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
³ Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
⁴ Gavi, the Vaccine Alliance, Global Health Campus, Chemin du Pommier 40, 1218 Le Grand-Saconnex, Switzerland.
⁵ Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA. Electronic address: dsalmon1@jhu.edu.

PMID: 36435704
DOI: 10.1016/j.vaccine.2022.11.004

Abstract

Background: Vaccine confidence and coverage decreased following a death temporally but not causally related to measles vaccination in Ukraine in 2008. Large measles outbreaks including international exportations followed. Herein we characterize this experience including associated costs.

Methods: Mixed-methods were used to characterize this vaccine safety incident and quantify health and economic costs. Qualitative interviews illuminate the incident, social climate, and corruption that influenced vaccine confidence in Ukraine. A literature review explored attitudes toward vaccines in the USSR and post-independence Ukraine. Infectious disease incidence was examined before and after the vaccine safety incident. An economic analysis estimated associated healthcare costs, including prevention and outbreak control measures, additional vaccination activities due to failure of the 2008 campaign, treatment costs for new cases domestically and foreign exportation, and productivity loss from treatment time and mortality for new cases.

Findings: Vaccine hesitancy and distrust in government and public health programs due to corruption existed in Ukraine before the vaccine safety incident. The mishandling of the 2008 incident catalyzed the decline of vaccine confidence and prompted poor procurement decisions, leading to a drop in infant vaccination coverage, increased domestic measles cases, and exportation of measles. The estimated cost of this incident was approximately $140 million from 2008 to 2018.

Interpretation: Absent a rapid and credible vaccine safety response, a coincidental death following immunization resulted in major outbreaks of measles with substantial economic costs. Adequate investments in a post-licensure safety system may help avoid similar future incidents.

Keywords: Confidence; Safety; Safety systems; Ukraine.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Humans
Infant
Measles Vaccine* / adverse effects
Measles* / epidemiology
Measles* / prevention & control
Ukraine / epidemiology
Vaccination / adverse effects
Vaccination Coverage
Vaccines* / adverse effects

Substances

Measles Vaccine
Vaccines