The Health and Economic Benefits Possible with Novel Tuberculosis Vaccines – A Modeling Study in India and Indonesia

Health and economic benefits possible with emerging tuberculosis vaccines are not fully known. We estimated gains possible with novel post-exposure vaccines, in India and Indonesia. We modeled vaccine impact on TB incidence, TB mortality, and on national income growth and the intrinsic value of living longer, known as Full-income. We considered several vaccine efficacies, initiation and scale-up scenarios. We found that if all age groups are vaccinated in 2025, then 2.3 million TB deaths in India and 695,000 TB deaths in Indonesia can be prevented, adding 0.09 years and 0.17 years to individual life expectancy at birth, on average annually. Full-income savings is US$2 trillion in India and US$680 billion in Indonesia. Even if delayed until 2030, 1.6 million deaths in India and 489,000 deaths in Indonesia can be prevented, with full-income savings of US$1.5 trillion and US$490 billion. These benefits suggest that further investment in the vaccines is prudent.Significance Statement There are no prior economic evaluations of candidate tuberculosis vaccines. Our study addresses this gap to answer two questions: (1) is there value in making the vaccine available given the efficacies demonstrated to date; and (2) is there an optimal time window for making the vaccine available. The conclusions in relation to these two questions are important because: (1) they are based on findings from two countries, which jointly account for 35% of global TB incidence and 38.8% of global TB mortality in 2019; (2) they provide guidance for future investment in the vaccine and roll-out in those countries.