Potential health and economic impact of paediatric vaccination using next-generation influenza vaccines in Kenya: a modelling study

Naomi R. Waterlow*, Sreejith Radhakrishnan, Jeanette Dawa, Edwin van Leeuwen, Simon R. Procter, Philipp Lambach, Joseph Bresee, Marie Mazur, Rosalind M. Eggo, Mark Jit

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Background: Influenza is a major year-round cause of respiratory illness in Kenya, particularly in children under 5. Current influenza vaccines result in short-term, strain-specific immunity and were found in a previous study not to be cost-effective in Kenya. However, next-generation vaccines are in development that may have a greater impact and cost-effectiveness profile. Methods: We expanded a model previously used to evaluate the cost-effectiveness of seasonal influenza vaccines in Kenya to include next-generation vaccines by allowing for enhanced vaccine characteristics and multi-annual immunity. We specifically examined vaccinating children under 5 years of age with improved vaccines, evaluating vaccines with combinations of increased vaccine effectiveness, cross-protection between strains (breadth) and duration of immunity. We evaluated cost-effectiveness using incremental cost-effectiveness ratios (ICERs) and incremental net monetary benefits (INMBs) for a range of values for the willingness-to-pay (WTP) per DALY averted. Finally, we estimated threshold per-dose vaccine prices at which vaccination becomes cost-effective. Results: Next-generation vaccines can be cost-effective, dependent on the vaccine characteristics and assumed WTP thresholds. Universal vaccines (assumed to provide long-term and broad immunity) are most cost-effective in Kenya across three of four WTP thresholds evaluated, with the lowest median value of ICER per DALY averted ($263, 95% Credible Interval (CrI): $ − 1698, $1061) and the highest median INMBs. At a WTP of $623, universal vaccines are cost-effective at or below a median price of $5.16 per dose (95% CrI: $0.94, $18.57). We also show that the assumed mechanism underlying infection-derived immunity strongly impacts vaccine outcomes. Conclusions: This evaluation provides evidence for country-level decision makers about future next-generation vaccine introduction, as well as global research funders about the potential market for these vaccines. Next-generation vaccines may offer a cost-effective intervention to reduce influenza burden in low-income countries with year-round seasonality like Kenya.

Original languageEnglish
Article number106
JournalBMC Medicine
Issue number1
Publication statusPublished - Dec 2023

Bibliographical note

Funding Information:
NRW, SR, SP, RME, JD and MJ were funded through the Task Force for Global Health in collaboration with the Partnership for Influenza Vaccine Introduction (PIVI), Ready2Respond, Wellcome Trust and Centres for Disease Control and Prevention (CDC). JB was funded by PIVI and CDC. EvL and RME were also supported by the National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Modelling and Health Economics, a partnership between UK HSA, Imperial College London, and LSHTM (grant number NIHR200908) and EvL was also supported by the European Union's Horizon 2020 research and innovation programme—project EpiPose (101003688).

Publisher Copyright:
© 2023, The Author(s).


  • Cost-effectiveness
  • Health economics
  • Influenza
  • Mathematical modelling
  • Next-generation vaccines
  • Vaccination


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