Pneumococcal Vaccination 1p + 1 Schedule Could Save $1.5 Billion

Pneumococcal vaccines, conjugate and polysaccharide, are approved by CDC

When a vaccine study reports that less is more, people pay attention.

In The Lancet Infectious Disease, David Goldblatt and colleagues reported the immunogenicity results of an innovative two-dose Pneumococcal conjugate vaccine (PCV) infant vaccination schedule.

As expected, these researchers found the immunogenicity of a single vaccine dose was inferior to two doses.

However, when a single PCV booster dose was administered to either the one or two dose schedule, the person produced similar immunogenicity.

This means, there may be a more cost effective, and less invasive, approach to controlling pneumococcal disease.

This UK-based immunogenicity study has the potential to initiate a sequence of events that could:

  • reduce the number of PCV doses needed by programmes,
  • provide enhanced global PCV access, and
  • save billions of dollars in the process.

But, this study’s assumption is based upon a community-wide immunity program, that maintains the public health and individual protection gains already achieved.

Since 2007, PCV has been integrated into national immunisation programs in 141 countries, according to the World Health Organization.

However, the variable cost of PCV threatens these programs, and their existing success.

In 2017, a report found that PCV prices ranged from US $3·05 per dose for the poorest countries of the world receiving support from Gavi, the Vaccine Alliance, to $169 per dose in the US private sector.

Many middle-income countries, too wealthy for financial support, but unable to afford market driven prices, find themselves priced out of the PCV market.

But, if Gavi-eligible countries alone were able to switch to to this proposed 1p + 1 schedule, the estimated savings is roughly $1·5 billion over a 10-year time period.

This means, there may be a compelling “less is more” financial immunization proposition.

But, much still needs to be assessed before that protocol switch could happen.

In the USA, there are two types of pneumococcal vaccines, conjugate vaccines and polysaccharide vaccines, approved by the Centers for Disease Control and Prevention (CDC).

The CDC recommends vaccination with the pneumococcal conjugate vaccine PCV13 or Prevnar13 for: 

  • All babies and children younger than 2 years old
  • All adults 65 years or older
  • People 2 through 64 years old who are at increased risk for disease due to certain medical conditions

Separately, the CDC recommends vaccination with the pneumococcal polysaccharide vaccine PPSV23 or Pneumovax23 for:

  • All adults 65 years or older
  • People 2 through 64 years old who are at increased risk for disease due to certain medical conditions
  • Adults 19 through 64 years old who smoke cigarettes

The CDC Vaccine Price List provides private sector vaccine prices for general information.

Vaccine discount information in the USA can be found here.

These researchers did not disclose any conflicts of interest. Funding for this research was provided by NIHR and the Bill & Melinda Gates Foundation.