Whittington - Cholera

1. Cholera Vaccination
Presentation by Dale Whittington
University of North Carolina at Chapel Hill (USA) and
the Manchester Business School (UK)
May 1, 2017

2. Cholera:
Status Quo Conditions in Rural Haiti
Since 2010 …
hundreds of thousands of cases;
~ 10,000 deaths
From Jan - Dec 2016 …
Haiti had 38,646 new cholera cases;
422 deaths

3. Vaccinations in Haiti
As of 2017, more than 1 million Haitians have received
vaccinations against cholera (of a total population of ≈ 10
million)
The oral cholera vaccines used in Haiti provide short-lived
protection against cholera (approximately 3 years), so re-
vaccination is also needed.

4. Costs of Vaccination
• Purchase: ≈ US$1.00 per
dose
• Delivery: ≈ US$1.00 per
dose
• Cost of time to receive a
dose: ≈ US$0.08
• ⇒ One dose ≈ US$2.08
• ⇒ Two doses ≈ US$4.16

5. Benefits of Vaccination
• Benefits from avoided loss of DALYs for vaccinated
population.
• Benefits from avoided lost of DALYs for unvaccinated
population.
• Health benefits are a function of the percent of the
population vaccinated and the extent of the herd immunity
effects.

6. Herd Immunity

7. 1st analyzed solution
Mass Vaccination with 2 doses of
oral cholera vaccine
Monthly costs per household:
US$0.38
Monthly benefits per household:
US$0.80
Benefit-Cost Ratio: 2.1
+

8. 2nd analyzed solution
Mass Vaccination with 1 dose of oral
cholera vaccine
Monthly costs per household: US$0.19
Monthly benefits per household: US$0.66
Benefit-Cost Ratio: 3.5
+

9. 3rd analyzed solution
School Vaccination with 2 doses
of oral cholera vaccine
Monthly Costs per household:
US$0.09
Monthly Benefits per household:
US$0.39
Benefit-Cost Ratio: 4.5 +

10. 4th analyzed solution
School Vaccination with 1 dose of
oral cholera vaccine
Monthly Costs per household:
US$0.04
Monthly Benefits per household:
US$0.26
Benefit-Cost Ratio: 5.9
+

11. Summary ( 5%, DALY = 3X GDP per capita)
Intervention Benefits Costs Benefit-Cost
Ratio
Mass Vaccination: 2 doses US$0.80 US$0.38 2.1
Mass Vaccination: 1 dose
US$0.66 US$0.19 3.5
School Vaccination: 2 doses
US$0.39 US$0.09 4.5
School Vaccination: 1 dose
US$0.26 US$0.04 5.9
Note: Benefit-cost ratios reported in table are correct; differences are due to rounding errors.

12. Sensitivity Analyses: School Vaccination: One
dose

13. Sensitivity Analyses: Mass Vaccination: Two
doses

14. Multi-Parameter Sensitivity Analyses