Estimating the global demand curve for a leishmaniasis vaccine: a generalisable approach based on global burden of disease estimates

BackgroundA pressing need exists to develop vaccines for neglected diseases, including leishmaniasis. However, the development of new vaccines is dependent on their value to two key players - vaccine developers and manufacturers who need to have confidence in the global demand in order to commit to research and production; and governments (or other international funders) who need to signal demand based on the potential public health benefits of the vaccine in their local context, as well as its affordability. A detailed global epidemiological analysis is rarely available before a vaccine enters a market due to lack of resources as well as insufficient global data necessary for such an analysis. Our study seeks to bridge this information gap by providing a generalisable approach to estimating the commercial and public health value of a vaccine in development relying primarily on publicly available Global Burden of Disease (GBD) data. This simplified approach is easily replicable and can be used to guide discussions and investments into vaccines and other health technologies where evidence constraints exist. The approach is demonstrated through the estimation of the demand curve for a future leishmaniasis vaccine. Methodology/Principal findingsWe project the ability to pay over the period 2030-2040 for a vaccine preventing cutaneous and visceral leishmaniasis (CL / VL), using an illustrative set of countries which account for most of the global disease burden. First, based on previous work on vaccine demand projections in these countries and CL / VL GBD-reported incidence rates, we project the potential long-term impact of the vaccine on disability-adjusted life years (DALYs) averted as a result of reduced incidence. Then, we apply an economic framework to our estimates to determine vaccine affordability based on the abilities to pay of governments and global funders, leading to estimates of the demand and market size. Based on our estimates, the maximum ability-to-pay of a leishmaniasis vaccine (per course, including delivery costs), given the current estimates of incidence and population at risk, is higher than $5 for nearly half of the 24 countries considered, with a median value-based maximum price of $4.4-$5.3, and total demand of over 560 million courses. Conclusion/SignificanceOur results demonstrate that both the quantity of vaccines estimated to be required by the countries considered as well as their ability-to-pay could make a vaccine for leishmaniasis commercially attractive to potential manufacturers. The methodology used can be equally applied to other technology developments targeting health in developing countries. Author summaryAs of 2019, between 498,000 and 862,000 new cases of all forms of leishmaniasis were estimated to occur each year resulting in up to 18,700 deaths and up to 1.6 million DALYs lost. Given low treatment coverage, poor compliance and the emergence of drug resistance, challenges in sustaining vector control strategies and the ability of parasites to persist in animal reservoirs independent of human infection, an effective vaccine could significantly reduce the health and economic burden of these diseases. However, commitment to the development of a new vaccine requires a market signal from governments and global funders who in turn require better estimates of the potential public health value of the vaccine. This study uses the development of a leishmaniasis vaccine as a case study to illustrate a generalizable approach to estimating the commercial and public health value of a technology relying primarily on publicly available GBD data. More specifically, by projecting the potential public health impact of the rollout of a leishmaniasis vaccine and translating this into monetary values based on the concept of health opportunity cost, we estimate the demand curve for such a vaccine for an 11-year period between 2030 and 2040. At an estimated global demand of over 560 million courses and a median value-based maximum price of $4.4-$5.3, our results demonstrate that both the quantity of vaccines estimated to be required by the countries considered as well as their ability-to-pay make the vaccine commercially attractive to potential manufacturers.