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Administering smaller doses of COVID-19 vaccines could be economically viable and could save more lives than either full-dose vaccination or no vaccination in low- and middle-income countries (LMICs)—even with the emergence of new, more highly transmissible variants, according to a cost-effectiveness modeling study.
Assuming a vaccine supply shortage, the study estimated the costs of hospitalization and vaccination and the economic benefits of averting COVID-19 deaths that would accrue if lower doses were administered in India. Shortages are most likely to occur in LMICs, where about 82% of the world’s population resides; the vaccination rate was 11% for low-income countries and 47% for middle-income countries in mid-January of this year.
Reducing the vaccine dose increased net monetary benefit under a wide range of transmission and vaccine efficacy assumptions in the modeling study. A ⅛ dose is the optimal strategy regardless of transmission rate, the study found. During high community transmission, the approach could save an estimated 4 million life-years at a cost of $10.63 billion. During times of low transmission, 11.34 million life-years could be saved at a cost of $8.8 billion.
Although fractional-dose strategies have potential for mitigating the public health and economic burdens of vaccine shortages, their adoption will depend on many factors, including ethical considerations and acceptability in specific country settings. Further clinical, policy, and operational research is needed, the authors wrote.
However, they noted that fractional vaccine doses already have been used for young children and for booster doses. Fractional doses might be most suitable for patients who were previously infected or vaccinated, according to the authors.
Créditos: Comité científico Covid