What did we take away from our work on vaccines

We investigated the cost-effectiveness of vaccine research and development to learn about how cost-effectiveness estimates are made and where they might go wrong. By doing this, we became far more wary of taking these estimates literally. Many people will do things like reducing their cost-effectiveness estimate by a factor of 10x and call this a conservative estimate, but in light of this exercise and other examples, this is not enough. Furthermore, our research underscored that donating to the Against Malaria Foundation (AMF) may be a really hard baseline to beat and that it is important to do some degree of investigation before assuming things beat AMF. Lastly, our research has some implications for biosecurity that merit further exploration.

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What is the cost-effectiveness of developing a vaccine?

We looked at academic literature for vaccine cost-effectiveness as a whole and we also performed individual case studies on seven contemporary and historical vaccines to try to estimate the total cost-effectiveness of researching and developing a vaccine from scratch. Looking back historically, we find a range of $0.50 to $1600 per DALY, depending on the vaccine. Using this historical information, we derive an estimate for the total cost-effectiveness of developing and rolling out a “typical” / ”average” vaccine as being $18 - $7000 / DALY. The smallpox vaccine, malaria vaccine, and rotavirus vaccine may all be more cost-effective investments in total than marginal investments in distributing bednets (see Appendix C), especially when pursued to the point of completely eradicating the disease. However, there are many important assumptions made by these models, and changing them could strengthen or undermine these conclusions.

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Analyzing the health and economic benefits of vaccines

Previously we estimated how expensive it is to research and develop a vaccine and also how expensive it is to roll-out a vaccine. If vaccines are to be cost-effective, we need to realise significant benefits in return for this expenditure. So let’s take a closer look at the specific and tangible benefits that vaccines have shown to provide, both for our health and the economy.

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Analyzing the cost of vaccine distribution

We previously estimated the cost of developing a vaccine from scratch to be $460M to $1.9B with a mean of $960M. However, this still does not tell us the full cost of a vaccine, because developing a vaccine but then not ever using it accomplishes nothing. Instead, you need to roll out the vaccine to people, which costs more money. Thus, vaccine R&D could be thought of as “unlocking” the opportunity to roll-out a vaccine, and the hope is that the high cost-effectiveness of rolling out a vaccine will help offset the high cost of vaccine R&D.

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How much does it cost to research and develop a vaccine?

Previously, we estimated how long it takes to research and develop a vaccine and came up with a conclusion that it would take “an average of 29 years [to develop a] typical vaccine, though with high uncertainty based on uncertainties in each approach and on many particular vaccines not being typical”. However, if we want to know the cost-effectiveness of vaccine research, it’s not enough to know how long a vaccine takes, but how much total money it would cost.

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Analyzing the timeline of vaccine research

Interventions related to vaccines seem to be highly cost-effective. The World Health Organization calls vaccines “one of the most powerful and cost-effective of all health interventions." (WHO, 2009, pXIV) and the Copenhagen Consensus says that "[v]accination may be the most effective public health intervention of all time” (Copenhagen Consensus Center Guide to Giving 2011, p37). GiveWell finds vaccine-related interventions to be highly cost-effective and have recommended one-off donations to vaccines on multiple occasions 1 through Incubation Grants. However, GiveWell has historically struggled to find room for more funding in this area2.

How cost-effective might developing new vaccines be? GAVI, the leading funder for vaccine-related work, is cited by a few different sources as potentially saving a life for under $10003, though this estimate is not robust and this estimate is not related solely to work on developing new vaccines. I’d be curious to see more work on evaluating this for a few reasons:

  1. It seems valuable as a benchmark to see how other interventions compare to vaccine-related work.

  2. Comparing differences of cost-effectiveness within vaccine-related work (e.g., developing new vaccines versus further distributing vaccines that already exist) can aid our understanding of how interventions and implementations of interventions can differ.

  3. Assessing the value of R&D for new vaccines could help us understand the value of funding R&D more generally.

Before looking in depth at the cost-effectiveness of vaccines, my first question was how long it takes to make a vaccine.

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