As the COVID-19 pandemic continues to unfold, it has become increasingly accepted that day-to-day life will not return to anything close to normality until a vaccine or effective treatment is available and widely accessible.¹

There are numerous vaccine candidates in development, though it is expected that an effective vaccine will not be available before the end of 2020, and instead will likely be available in the first half of 2021 at earliest.^2,3 It is also likely that the vaccine will not have sufficient availability to be given to the entire population of need at once. It is estimated that it may take a year, or even two years, to vaccinate the eligible global population to be vaccine assuming that the price of the vaccine price is not a barrier.⁴

As a result, governments worldwide will have to consider a number of important questions before implementing a COVID-19 vaccination programme:

• Which population groups should be prioritised for vaccination in each country?
• How many people should the government aim to vaccinate?
• Are there any measures e.g. antibody testing before vaccination that can maximise the impact of available vaccines in the first place?
• What price should the government be prepared to pay for the vaccine?

The answers to these questions will vary depending on the characteristics of the vaccine that becomes available. The efficacy (in terms of both reduction of COVID-19 infection risk and severity), number of doses required and cold chain storage requirements of a COVID-19 vaccine at this stage are all unclear.

Early health technology assessment (HTA) is a scientific method that can be combined with mathematical modelling to understand the potential added value of pipeline or hypothetical health innovations, whereas traditional HTA assesses the added value of health innovations when the characteristics of the innovation are well-established. This means that early HTA can help shape the development of COVID-19 vaccines by informing preferable vaccine characteristics (e.g. safety and efficacy profiles, mode of administration, number of vaccine doses, vaccine storage requirements, target populations, vaccine purchasing and delivery costs) that can maximise the public health impact whilst representing good value for money in each setting. Early HTA can also help to inform clinical trials design, including the selection of appropriate surrogate outcomes and efficient sample sizes.⁵

Conducting early HTA analyses would also streamline and accelerate the decision-making process when a COVID-19 vaccine does become available, as a range of hypothetical characteristics will have been explored already and these can feed into the final HTA analyses, whilst providing an early understanding of how and whether a realised vaccine should be utilised. By understanding and setting minimum performance thresholds for a COVID-19 vaccine, early HTA will help to shorten the deliberation process before deciding how and whether to implement a realised COVID-19 vaccine.

Low- and middle-income countries should consider conducting early HTA assessments for implementation of a COVID-19 vaccine in their settings to ensure that they are well-prepared for pricing negotiations and coverage decisions once a vaccine becomes available. There are early HTA appraisal studies of a COVID-19 vaccine underway in Thailand and Singapore already, to find out more details about these projects please contact Dr. Yot Teerawattananon ([email protected]) and Dr. Hannah Clapham ([email protected]), respectively.

References

1. Coronavirus: Significant social distancing needed “until vaccine found.” BBC News. https://www.bbc.com/news/uk-52308201. Published 2020. Accessed June 1, 2020.

2. Coronavirus vaccine: When will we have one? BBC News. https://www.bbc.com/news/health-51665497.dit. Published 2020. Accessed June 1, 2020.

3. Thailand says it expects coronavirus vaccine next year after tests in mice. The Jakarta Post. https://www.thejakartapost.com/seasia/2020/05/20/thailand-says-it-expects-coronavirus-vaccine-next-year-after-tests-in-mice.html. Published 2020. Accessed June 1, 2020.

4. Rowland C, Johnson CY, Wan W. Even finding a covid-19 vaccine won’t be enough to end the pandemic. The Washington Post. https://www.washingtonpost.com/business/2020/05/11/coronavirus-vaccine-global-supply/. Published 2020. Accessed June 4, 2020.

5. IJzerman M, Steuten L. Early Assessment of Medical Technologies to Inform Product Development and Market Access. Appl Health Econ Health Policy. 2011;9:331-347. doi:10.2165/11593380-000000000-00000