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BackgroundProgress towards measles and rubella (MR) elimination has stagnated as countries are unable to reach the required 95% vaccine coverage. Microarray patches (MAPs) are anticipated to offer significant programmatic advantages to needle and syringe (N/S) presentation and increase MR vaccination coverage. A demand forecast analysis of the programmatic doses required (PDR) could accelerate MR-MAP development by informing the size and return of the investment required to manufacture MAPs.MethodsUnconstrained global MR-MAP demand for 2030-2040 was estimated for three scenarios, for groups of countries with similar characteristics (archetypes), and four types of uses of MR-MAPs (use cases). The base scenario 1 assumed that MR-MAPs would replace a share of MR doses delivered by N/S, and that MAPs can reach a proportion of previously unimmunised populations. Scenario 2 assumed that MR-MAPs would be piloted in selected countries in each region of the World Health Organization (WHO); and scenario 3 explored introduction of MR-MAPs earlier in countries with the lowest measles vaccine coverage and highest MR disease burden.ResultsFor the base scenario (1), the estimated global PDR for MR-MAPs was forecasted at 30 million doses in 2030 and increased to 220 million doses by 2040. Compared to scenario 1, scenario 2 resulted in an overall decrease in PDR of 18%, and scenario 3 resulted in a 21% increase in PDR between 2030-2040.ConclusionsSignificant demand is expected for MR-MAPs between 2030-2040, however, efforts are required to address remaining data quality, uncertainties and gaps that underpin the assumptions in this analysis.Key pointsthe delivery of measles and rubella vaccines with microarray patches (MR-MAPs) could disrupt the immunization landscape. We estimated the demand for MR-MAPs between 2030-2040 at 4.05 billion doses. This analysis will inform the size of investment required to manufacture MR-MAPs.

BackgroundTuberculosis is a leading infectious cause of death worldwide. Novel vaccines will be required to reach global targets and reverse setbacks from the COVID-19 pandemic. We estimated the impact of novel tuberculosis vaccines in low- and middle-income countries (LMICs) under alternative delivery scenarios.MethodsWe calibrated a tuberculosis model to 105 LMICs (93% of global tuberculosis incidence). Vaccine scenarios were implemented asBasecase: routine vaccination of 9-year-olds and a one-time vaccination campaign for ages ≥10 with country-specific introduction between 2028–2047 and 5-year scale-up to target coverage;Accelerated Scale-up: asBasecase, but all countries introducing in 2025 with instant scale-up; andRoutine Only: asBasecase, but routine vaccination only. Vaccines protected against disease for 10-years, with 50% efficacy.FindingsTheBasecasescenario prevented 44.0 (95% uncertainty range=37.2–51.6) million tuberculosis cases, and 5.0 (4.6–5.4) million tuberculosis deaths before 2050, including 2.2 million in the WHO South-East Asian region. TheAccelerated Scale-upscenario prevented 65.5 (55.6–76.0) million cases and 7.9 (7.3–8.5) million deaths before 2050. TheRoutine Onlyscenario prevented 8.8 (7.6–10.1) million cases and 1.1 (0.9–1.2) million deaths before 2050.InterpretationsNovel tuberculosis vaccines could have substantial impact, which will vary depending on delivery strategy. Including a campaign will be crucial for rapid impact. Accelerated introduction, more similar to the pace of COVID-19 vaccines, could increase lives saved by around 60%. Investment is required to support vaccine development, manufacturing, prompt introduction and scale-up.FundingWHO (2020/985800-0)