Estimates of the Global Burden of COVID-19 and the Value of Broad and Equitable Access to COVID-19 Vaccines
2. Materials and Methods
2.1. Estimating the COVID-19 Burden
2.2. Estimating the Value of Global Access to COVID-19 Vaccines
2.2.1. The Value of Global Access to COVID-19 Vaccines to Health and Healthcare Systems
- Scenario 1 estimated the global value of vaccines in reducing direct (reported) and excess (estimated direct unreported and estimated indirect) deaths, direct hospitalisations, and direct healthcare system resource use due to COVID-19 in 2021, given the computed, country-specific monthly coverage rates between January and September 2021 . Publicly available projections for country-specific vaccination rates for the time between September 2021 and December 2021 were applied to yield coverage estimates for the rest of the year .
- Scenario 2 estimated the potential additional value that could have been achieved by the end of 2021 if at least 40% of the population in each of the 92 countries eligible for COVAX AMC (the AMC92) access would have been fully vaccinated. Scenario 2 is aligned with the World Health Organization (WHO) Strategy to Achieve Global COVID-19 Vaccination by mid-2022  and the International Monetary Fund (IMF) Proposal to End the Pandemic . The target was to vaccinate at least 40% in each country worldwide by the end of 2021, and the proposal was estimated to cost approximately USD 9 trillion, mainly in additional upfront grants to COVAX for purchasing vaccines .
2.2.2. The Economic Value of Global Access to COVID-19 Vaccines
- Estimates from the ICC: The ICC’s paper “The Economic Case for Global Vaccinations”  uses an epidemiological susceptible−infected−recovered (SIR) model with an international trade and production network to estimate the economic costs of COVID-19 during a single year that were solely due to international linkages. The most realistic scenario (as identified by the authors) assumed that, in advanced economies, half of the susceptible population was vaccinated within the first 30 days of the vaccination programme starting, and the remaining half was vaccinated within the following 90 days. In less advanced economies, the vaccination program started at the same time, but it took a full year to vaccinate half of the susceptible population. The model estimated the economic losses associated with this scenario, compared to a hypothetical scenario of full vaccination in both advanced economies and less advanced economies. In other words, this scenario provides an estimate of the economic value which would be generated if vaccination coverage in less advanced economies increased from 50% to 100%. Note that the IMF categorises all countries as advanced economies, emerging markets, or developing economies. The main criteria used are  per capita income level,  export diversification—so oil exporters that have high per capita GDP would not make the advanced classification because around 70% of their exports are oil—and  degree of in-tegration into the global financial system. For the purposes of this article, we refer to emerging markets and developing countries collectively as ‘less advanced economies’ .
- Estimates from the IMF: The IMF’s Proposal to End the Pandemic , launched in May 2021, set the target of vaccinating at least 40% of the population of every country worldwide by the end of 2021 and 60% by mid-2022, and provided estimates of the costs of this proposal. To generate a conservative estimate of the total incremental costs of fully vaccinating every country, we summed the cost of vaccinating 60% of the AMC92 countries (USD 50 billion for the IMF’s proposal to reach 40% vaccination coverage in every country worldwide by the end of 2021 and 60% by mid-2022) with the costs of increasing coverage from 60% to 100% in lower MICs (USD 16 billion, assuming a cost of USD 4 billion per 10 percentage point increase, as indicated in the IMF’s proposal). This assumes that HICs have already purchased or ordered vaccines sufficient to achieve at least 100% domestic coverage.
- Analysis: Dividing the economic value of moving from 50% to 100% vaccination coverage in less advanced economies, by the cost of moving from current vaccination levels (in May 2021, when the IMF proposal was written, and most countries eligible for AMC92 access had not reached 20% vaccination coverage) to 100% vaccination, provides a conservative estimate of the return on investment to vaccination. Full details of how we used these sources to develop estimates of the economic value of global access to vaccines are available in Appendix C.
3.1. Estimates of the COVID-19 Burden
3.1.1. Impact on Length of Life
3.1.2. Impact on QoL
3.1.3. Impact on Health System Resource Use
3.1.4. Impact on Macroeconomic Performance
3.2. The Value of COVID-19 Vaccines
3.2.1. The Value of COVID-19 Vaccines to Health and Healthcare Systems
3.2.2. The Economic Value of COVID-19 Vaccines
4.1. Estimates of the COVID-19 Burden
4.2. Estimates of the Health Value of COVID-19 Vaccines
4.3. Estimates of the Economic Value of COVID-19 Vaccines
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A. Methodology for Estimating the Global COVID-19 Burden
Appendix A.1. Search Strategy
|Effect Category||Element||Definition||Direct Effect Example||Indirect Effect Example|
|Health effects||Impact on length of life||Impact on mortality.||Death due to a COVID-19 infection.||Death due to cancer, because of delayed or cancelled treatment.|
|Impact on patients’ quality of life||Impact on physical, mental, emotional, and social functioning.||Reduced long-term physical functioning due to long COVID.||Mental health deterioration because of a lockdown.|
|Economic effects||Impact on health system resource use||While there are costs associated with any health care intervention, vaccines may also create value in the form of cost offsets.||The costs associated with treating a patient hospitalised with COVID-19.||Initial reduction in cost for alternative treatments which have been cancelled or paused.|
|Macroeconomic impact||The COVID-19 pandemic will have effects on GDP in the short run, for example because of lower productivity during lockdowns. The pandemic will also have long-run effects on GDP. For example, interruptions to education will reduce lifetime productivity.||A country with higher COVID-19 infection rates has a smaller healthy workforce.||Lockdown measures increase unemployment.|
Appendix A.2. List of Papers Used for Literature Review Snowballing Strategy
Appendix B. Methodology for Estimating the Value of COVID-19 Vaccines to Health and Healthcare Systems
Appendix B.1. Dataset Preparation
|Income Class||Number of Countries||Share of the Total Population in Dataset|
|High-income countries (HICs)||53||16%|
|Upper middle-income countries (upper MICs)||43||34%|
|Lower middle-income countries (lower MICs]||41||43%|
Appendix B.2. Outcomes of Interest
|Outcome||Description (Adapted from IHME)|
|Number of infections||The number of people that are infected with COVID-19 each day, including those not tested, estimated by IHME.|
|Total number of direct deaths from COVID-19||The estimated number of deaths attributable to COVID-19, including unreported deaths, estimated by IHME.|
|Total number of hospital admission related to COVID-19||The mean of daily hospital admissions due to COVID-19, estimated by IHME|
|Total number of hospital beds||The total number of baseline hospital beds available for COVID-19 patients minus the average historical bed use. Any surge capacity is excluded. ICU beds are included in the number of All beds needed and All beds available.|
|Total number of ICU beds||ICU beds available is the total number of baseline ICU beds available for COVID-19 patients minus the average historical ICU bed use. Any surge capacity is excluded.|
Appendix B.3. Vaccine Effectiveness Rates against Outcomes
|Health Metric||Average Efficacy||Health Metric|
Appendix B.4. Global Value of Vaccination Model
Appendix C. Methodology for Estimating the Economic Value of COVID-19 Vaccines
Appendix C.1. Source 1: International Chamber of Commerce for the Value of Access to Vaccines
Appendix C.2. Source 2: International Monetary Fund for the Costs of Access to Vaccines
Appendix C.3. Calculations
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|Indicator||Global||HICs||Upper MICs||Lower MICs||LICs|
|Indicator||Global||HICs||Upper MICs||Lower MICs||LICs|
|Number of infections||261,997,120||115,614,258||81,732,626||63,268,956||1,381,280|
|Indicator||HICs||Upper MICs and Lower MICs||LICs|
|Per capita budget allocations for the COVID-19 response in 2020||USD 205||USD 20||USD 3.20|
|Per capita government spending on health, 2018||USD 2519||USD 158||USD 8.9|
|Percentage of government spending allocated to COVID-19||8.1%||12.7%||36.4%|
|Indicator||HICs||Upper MICs||Lower MICs||LICs|
|Indicator||HICs||Upper MICs||Lower MICs||LICs|
|Scenario 1||Avoided Direct Deaths||Avoided Excess Deaths||Avoided Hospitalisations||Avoided Hospital Beds||Avoided ICU Beds||Value of Beds Saved|
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Bell, E.; Brassel, S.; Oliver, E.; Schirrmacher, H.; Arnetorp, S.; Berg, K.; Darroch-Thompson, D.; Pohja-Hutchison, P.; Mungall, B.; Carroll, S.; et al. Estimates of the Global Burden of COVID-19 and the Value of Broad and Equitable Access to COVID-19 Vaccines. Vaccines 2022, 10, 1320. https://doi.org/10.3390/vaccines10081320
Bell E, Brassel S, Oliver E, Schirrmacher H, Arnetorp S, Berg K, Darroch-Thompson D, Pohja-Hutchison P, Mungall B, Carroll S, et al. Estimates of the Global Burden of COVID-19 and the Value of Broad and Equitable Access to COVID-19 Vaccines. Vaccines. 2022; 10(8):1320. https://doi.org/10.3390/vaccines10081320Chicago/Turabian Style
Bell, Eleanor, Simon Brassel, Edward Oliver, Hannah Schirrmacher, Sofie Arnetorp, Katja Berg, Duncan Darroch-Thompson, Paula Pohja-Hutchison, Bruce Mungall, Stuart Carroll, and et al. 2022. "Estimates of the Global Burden of COVID-19 and the Value of Broad and Equitable Access to COVID-19 Vaccines" Vaccines 10, no. 8: 1320. https://doi.org/10.3390/vaccines10081320