Cost-effectiveness of COVID-19 vaccination in low- and middle-income countries

Summary Despite the advent of safe and highly effective COVID-19 vaccines 1–4 , pervasive inequities in global distribution persist 5 . In response, multinational partners have proposed programs to allocate vaccines to low- and middle-income countries (LMICs) 6 . Yet, there remains a substantial funding gap for such programs 7 . Further, the optimal vaccine supply is unknown and the cost-effectiveness of investments into global vaccination programs has not been described. We used a validated COVID-19 simulation model 8 to project the health benefits and costs of reaching 20%-70% vaccine coverage in 91 LMICs. We show that funding 20% vaccine coverage over one year among 91 LMICs would prevent 294 million infections and 2 million deaths, with 26 million years of life saved at a cost of US$6.4 billion, for an incremental cost effectiveness ratio (ICER) of US$250/year of life saved (YLS). Increasing vaccine coverage up to 50% would prevent millions more infections and save hundreds of thousands of additional lives, with ICERs below US$8,000/YLS. Results were robust to variations in vaccine efficacy and hesitancy, but were more sensitive to assumptions about epidemic pace and vaccination costs. These results support efforts to fund vaccination programs in LMICs and complement arguments about health equity 9 , economic benefits 10 , and pandemic control 11 .