TY - JOUR
T1 - Projecting vaccine demand and impact for emerging zoonotic pathogens
AU - Lerch, Anita
AU - ten Bosch, Quirine A.
AU - L’Azou Jackson, Maïna
AU - Bettis, Alison A.
AU - Bernuzzi, Mauro
AU - Murphy, Georgina A.V.
AU - Tran, Quan M.
AU - Huber, John H.
AU - Siraj, Amir S.
AU - Bron, Gebbiena M.
AU - Elliott, Margaret
AU - Hartlage, Carson S.
AU - Koh, Sojung
AU - Strimbu, Kathyrn
AU - Walters, Magdalene
AU - Perkins, T.A.
AU - Moore, Sean M.
PY - 2022/6/16
Y1 - 2022/6/16
N2 - Background: Despite large outbreaks in humans seeming improbable for a number of zoonotic pathogens, several pose a concern due to their epidemiological characteristics and evolutionary potential. To enable effective responses to these pathogens in the event that they undergo future emergence, the Coalition for Epidemic Preparedness Innovations is advancing the development of vaccines for several pathogens prioritized by the World Health Organization. A major challenge in this pursuit is anticipating demand for a vaccine stockpile to support outbreak response. Methods: We developed a modeling framework for outbreak response for emerging zoonoses under three reactive vaccination strategies to assess sustainable vaccine manufacturing needs, vaccine stockpile requirements, and the potential impact of the outbreak response. This framework incorporates geographically variable zoonotic spillover rates, human-to-human transmission, and the implementation of reactive vaccination campaigns in response to disease outbreaks. As proof of concept, we applied the framework to four priority pathogens: Lassa virus, Nipah virus, MERS coronavirus, and Rift Valley virus. Results: Annual vaccine regimen requirements for a population-wide strategy ranged from > 670,000 (95% prediction interval 0–3,630,000) regimens for Lassa virus to 1,190,000 (95% PrI 0–8,480,000) regimens for Rift Valley fever virus, while the regimens required for ring vaccination or targeting healthcare workers (HCWs) were several orders of magnitude lower (between 1/25 and 1/700) than those required by a population-wide strategy. For each pathogen and vaccination strategy, reactive vaccination typically prevented fewer than 10% of cases, because of their presently low R0 values. Targeting HCWs had a higher per-regimen impact than population-wide vaccination. Conclusions: Our framework provides a flexible methodology for estimating vaccine stockpile needs and the geographic distribution of demand under a range of outbreak response scenarios. Uncertainties in our model estimates highlight several knowledge gaps that need to be addressed to target vulnerable populations more accurately. These include surveillance gaps that mask the true geographic distribution of each pathogen, details of key routes of spillover from animal reservoirs to humans, and the role of human-to-human transmission outside of healthcare settings. In addition, our estimates are based on the current epidemiology of each pathogen, but pathogen evolution could alter vaccine stockpile requirements.
AB - Background: Despite large outbreaks in humans seeming improbable for a number of zoonotic pathogens, several pose a concern due to their epidemiological characteristics and evolutionary potential. To enable effective responses to these pathogens in the event that they undergo future emergence, the Coalition for Epidemic Preparedness Innovations is advancing the development of vaccines for several pathogens prioritized by the World Health Organization. A major challenge in this pursuit is anticipating demand for a vaccine stockpile to support outbreak response. Methods: We developed a modeling framework for outbreak response for emerging zoonoses under three reactive vaccination strategies to assess sustainable vaccine manufacturing needs, vaccine stockpile requirements, and the potential impact of the outbreak response. This framework incorporates geographically variable zoonotic spillover rates, human-to-human transmission, and the implementation of reactive vaccination campaigns in response to disease outbreaks. As proof of concept, we applied the framework to four priority pathogens: Lassa virus, Nipah virus, MERS coronavirus, and Rift Valley virus. Results: Annual vaccine regimen requirements for a population-wide strategy ranged from > 670,000 (95% prediction interval 0–3,630,000) regimens for Lassa virus to 1,190,000 (95% PrI 0–8,480,000) regimens for Rift Valley fever virus, while the regimens required for ring vaccination or targeting healthcare workers (HCWs) were several orders of magnitude lower (between 1/25 and 1/700) than those required by a population-wide strategy. For each pathogen and vaccination strategy, reactive vaccination typically prevented fewer than 10% of cases, because of their presently low R0 values. Targeting HCWs had a higher per-regimen impact than population-wide vaccination. Conclusions: Our framework provides a flexible methodology for estimating vaccine stockpile needs and the geographic distribution of demand under a range of outbreak response scenarios. Uncertainties in our model estimates highlight several knowledge gaps that need to be addressed to target vulnerable populations more accurately. These include surveillance gaps that mask the true geographic distribution of each pathogen, details of key routes of spillover from animal reservoirs to humans, and the role of human-to-human transmission outside of healthcare settings. In addition, our estimates are based on the current epidemiology of each pathogen, but pathogen evolution could alter vaccine stockpile requirements.
KW - Emerging disease
KW - Spillover
KW - Vaccine demand modeling
KW - Vaccine stockpile
KW - Zoonosis
KW - Zoonotic disease
UR - https://github.com/lerch-a/VaccineCampaign
UR - https://doi.org/10.6084/m9.figshare.c.6049817
U2 - 10.1186/s12916-022-02405-1
DO - 10.1186/s12916-022-02405-1
M3 - Article
C2 - 35705986
AN - SCOPUS:85132080647
SN - 1741-7015
VL - 20
JO - BMC Medicine
JF - BMC Medicine
IS - 1
M1 - 202
ER -