Cost-Effectiveness of Prophylactic Zika Virus Vaccine in the Americas

Affan Shoukat; Thomas Vilches; Seyed M. Moghadas


Emerging Infectious Diseases. 2019;25(12):2191-2196. 

In This Article

Abstract and Introduction


Zika virus remains a major public health concern because of its association with microcephaly and other neurologic disorders in newborns. A prophylactic vaccine has the potential to reduce disease incidence and eliminate birth defects resulting from prenatal Zika virus infection in future outbreaks. We evaluated the cost-effectiveness of a Zika vaccine candidate, assuming a protection efficacy of 60%–90%, for 18 countries in the Americas affected by the 2015–2017 Zika virus outbreaks. Encapsulating the demographics of these countries in an agent-based model, our results show that vaccinating women of reproductive age would be very cost-effective for sufficiently low (<$16) vaccination costs per recipient, depending on the country-specific Zika attack rate. In all countries studied, the median reduction of microcephaly was >75% with vaccination. These findings indicate that targeted vaccination of women of reproductive age is a noteworthy preventive measure for mitigating the effects of Zika virus infection in future outbreaks.


After the 2013–2014 Zika virus outbreak in French Polynesia,[1,2] the disease spread to 69 countries and territories worldwide.[3] The connection of Zika virus infection to prenatal microcephaly and other brain abnormalities[4–6] raised a public health emergency of international concern in February 2016.[7] Although this concern subsided with declining outbreaks in the Americas, a sizable portion of the population in the tropical world remains at risk for Zika virus infection, especially in countries where the primary transmitting vector (the Aedes aegypti mosquito) is abundant.[8] Furthermore, the economic burden of Zika virus infection is estimated to be substantial, ranging from $7 to $18 billion in short-term costs and $3.2 to $39 billion in long-term costs,[9] which highlights the need for preventive measures.

The potential for future outbreaks and devastating clinical outcomes with long-term sequelae has directed research efforts to develop an effective Zika virus preventive vaccine.[10–13] Several vaccine candidates have now advanced to clinical trials and have been shown to be safe and well tolerated in generating humoral immune responses.[14,15] For the strategic use of a prophylactic vaccine, a vaccine target product profile (VTPP) has been proposed by the World Health Organization and the United Nations Children's Fund, prioritizing women of reproductive age (15–49 years), including pregnant women.[16] To inform decisions on implementing the recommended VTPP, we evaluated the cost-effectiveness of a potential Zika virus vaccine in 18 countries in the Americas where the estimated attack rates (i.e., the proportion of the population infected) during the 2015–2017 outbreaks were >2%.[17,18]