ArticleBMJ public health2026
Provincial stratification and equity-weighted cost-effectiveness of malaria vaccines in Zambia under climate variability.
Article in BMJ public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Malaria remains a major public health burden in Zambia, with 5-6 million cases annually. Heterogeneous transmission complicates vaccine deployment. While RTS,S/AS01 has been piloted, the impact and cost-effectiveness of RTS,S and next-generation R21 require rigorous provincial-level evaluation. Methods: We developed a province-stratified susceptible, exposed, infectious and recovered (SEIR)-mosquito transmission model incorporating entomological inoculation rates, calibrated to routine surveillance data. The model generated expressions for the basic reproduction number (R₀) and herd immunity thresholds. Cost-effectiveness was assessed from the Zambia Ministry of Health perspective over a 5-year analytic horizon (2024-2028), with 3% annual discounting, using disability-adjusted life-years (DALYs) averted. Costs included procurement, delivery, cold-chain investment and treatment savings. Incremental cost-effectiveness ratios (ICERs) and probabilistic sensitivity analyses (10 000 simulations) were benchmarked against Zambia's US$500/DALY willingness-to-pay threshold. Equity was assessed via ICER distributions and concentration indices. Results: Over the 5-year analytic horizon, malaria vaccination substantially reduced transmission intensity and disease burden relative to a no-vaccination baseline, with marked heterogeneity across provinces. Nationally, deployment of the RTS,S vaccine was estimated to avert a median of 9.80 × 10 Conclusions: Provincial stratification highlights the need for targeted vaccine roll-out and infrastructure strengthening. RTS,S is borderline cost-effective at current prices, while R21 is highly cost-effective and potentially dominant. Findings support phased provincial deployment with equity weighting, budget integration and climate-adaptive investment to maximise health gains.
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