A Cost-Benefit Analysis of Cholera Vaccination Programs in Beira, Mozambique

Economic and epidemiological data collected in Beira, Mozambique, are used to conduct this first social cost-benefit analysis for cholera vaccination in Sub-Saharan Africa. The analysis compares the net economic benefits of three immunization strategies with and without user fees: school-based vaccination for school children only (age 5-14), school-based vaccination for all children (age 1-14), and a mass vaccination campaign for all people older than one year. All options assume the use of a low-cost new-generation oral cholera vaccine. The analysis incorporates the latest knowledge of vaccine effectiveness, including new evidence on the positive externality associated with the resulting herd protection (both protection of unvaccinated individuals and enhanced protection among vaccinated individuals arising from vaccination of a portion of the population). It also uses field data for incidence, benefits (private willingness to pay, public cost of illness), and costs (production, shipping, delivery, private travel costs). Taking herd protection into account has important economic implications. For a wide variety of parameters values, vaccination programs in Beira pass a cost-benefit test. Small school-based programs with and without user fees are very likely to provide net benefits. A mass vaccination campaign without user fees would result in the greatest reduction in the disease burden, but the social costs would likely outweigh the benefits, and such a program would require substantial public sector investment. As user fees increase, mass vaccination becomes much more attractive, and the reduction in disease burden remains above 70 percent at relatively low user fees.