Total costs associated with replicating and non-replicating smallpox vaccines

Routine vaccination against smallpox among the general public was discontinued more than three decades ago, resulting in a population that is increasingly susceptible to infection. Moreover, the likelihood of re-introduction of eradicated diseases, such as smallpox, increases with time primarily due to the rapid advancement of biotechnology. Our analysis outlines the relative contribution of each component to the total cost of immunisation as it compares replicating and non-replicating smallpox vaccines for the first time. We calculated the total cost of immunising one person using a replicating vaccine such as ACAM2000 was $139, while using a non-replicating vaccine (IMVAMUNE ® ) cost $115. Overall, the analysis indicates that the main cost component differences of replicating and non-replicating vaccines are made up of the need for screening, follow-up visit, adverse events, reimbursement and compensation when using replicating vaccines. These costs are almost perfectly balanced against the higher cost of goods, reduced productivity loss and the need for an extra vaccination visit when using a non-replicating vaccine. With the availability of a new vaccine option, preparedness planners will benefit from this analysis to support evidence-based decision-making when preparing a safe, efficacious and cost-effective stockpile and immunisation programme against smallpox.