Bryan Patenaude

Johns Hopkins Bloomberg School of Public Health | JHSPH · Department of International Health

In 2023, the world will be at “halftime” with respect to the sustainable development goals (SDGs). This midline acts as an important milestone to review the progress of the SDGs and develop policies based on the most effective interventions. To estimate the remaining resources needed to achieve SDG targets for vaccines from 2023 to 2030 as well the...

Background: Global routine childhood vaccine coverage has plateaued in recent years, and the COVID-19 pandemic further disrupted immunisation services. We estimated global and regional inequality of routine childhood vaccine coverage from 2019 to 2021, particularly assessing the impacts of the COVID-19 pandemic. Methods: We used longitudinal dat...

Background: Diarrhea is one of the leading -causes of morbidity and mortality among children under age five in Uganda. While there is an abundance of literature on disease burden, there is limited available evidence on the costs and economic burden of childhood diarrhea in Uganda. To fill this gap, we estimated the cost of childhood diarrhea in Uga...

Cambodia has exhibited great progress in achieving high coverage in nationally recommended immunizations. As vaccination program managers plan interventions to reach last-mile children, it is important to consider issues of equity immunization priority setting. In this analysis, we apply the VERSE Equity Tool to Cambodia’s Demographic and Health Su...

Nigeria experiences wide heterogeneity in vaccination rates by vaccine and region. However, inequities in vaccination status extend beyond just geographic covariates. Traditionally, inequity is represented by a single metric pertaining to socioeconomic status. A growing body of literature suggests that this view is limiting, and a multi-factor appr...

Introduction: Following a call from the World Health Organization in 2017 for a methodology to monitor immunization coverage equity in line with the 2030 Agenda for Sustainable Development, this study applies the Vaccine Economics Research for Sustainability and Equity (VERSE) vaccination equity toolkit to measure national-level inequity in immuni...

We estimated immunization program costs, financing, and funding gaps for sixteen vaccines among ninety-four low- and middle-income countries during the period 2011-30. Inputs were obtained from the Institute for Health Metrics and Evaluation, the 2020 Decade of Vaccine Economics costing analysis, the World Health Organization, Gavi, and the United...

Background: Integrating mental health services into primary care is a key strategy for reducing the mental healthcare treatment gap in low- and middle-income countries. We examined healthcare use and costs over time among individuals with depression and subclinical depressive symptoms in Chitwan, Nepal to understand the impact of integrated care o...

Background Restrictions to curb the first wave of COVID-19 in India resulted in a decline in facility-based HIV testing rates, likely contributing to increased HIV transmission and disease progression. The programmatic and economic impact of COVID-19 on index testing, a standardized contact tracing strategy, remains unknown. Methods Retrospective...

Importance: Measuring vaccination coverage rates and equity is crucial for informing immunization policies in China. Objectives: To estimate coverage rates and multidimensional equity for childhood vaccination in China. Design, setting, and participants: This cross-sectional study was conducted via a survey in 10 Chinese provinces between Augu...

Understanding the level of investment needed for the next decade is vital to achieve the goal of Immunization Agenda 2030 (IA2030). Through the immunization funder perspective, this study estimates both global and regional economic resources required to achieve IA2030 coverage among 194 WHO member countries from 2021-2030, against 14 pathogens: Hep...

Background Vaccine confidence and coverage decreased following a death temporally but not causally related to measles vaccination in Ukraine in 2008. Large measles outbreaks including international exportations followed. Herein we characterize this experience including associated costs. Methods Mixed-methods were used to characterize this vaccine...

Background Integrating services for depression into primary care is key to reducing the treatment gap in low- and middle-income countries. We examined the value of providing the Healthy Activity Programme (HAP), a behavioral activation psychological intervention, within services for depression delivered by primary care workers in Chitwan, Nepal usi...

Background Given patient preferences, the choice of delivery modality for vaccines against SARS-CoV-2 has the potential to significantly impact both health and economic consequences of an outbreak of COVID-19. This study models the projected health and economic impact of an oral COVID-19 vaccine in the United States during an outbreak occurring bet...

Background This study analyses vaccine coverage and equity among children under five years of age in Uganda based on the 2016 Uganda Demographic and Health Survey (UDHS) dataset. Understanding equity in vaccine access and the determinants is crucial for the redress of emerging as well as persistent inequities. Methods Applied to the UDHS for 2000,...

Objectives: Ecuador introduced the pneumococcal conjugate vaccine in 2010. A recent time series analysis has demonstrated the impact of 10-valent pneumococcal conjugate vaccine (PCV10) on hospitalized pneumococcal disease in children. We leveraged these estimates to calculate the return on investment (ROI) of PCV10 in Ecuador from 2010 to 2030 at...

Objective: To evaluate equity in the allocation and distribution of vaccines for coronavirus disease 2019 (COVID-19) to countries and territories participating in the COVID-19 Vaccines Global Access (COVAX) Facility. Methods: We used publicly available data on the numbers of COVAX vaccine doses allocated and distributed to 88 countries and terri...

Following a call from the World Health Organization in 2017 for a methodology to monitor immunization coverage equity in line with the 2030 Agenda for Sustainable Development, this study outlines a standardized approach for measuring multivariate equity in vaccine coverage, economic impact, and health outcomes. The Vaccine Economics Research for Su...

Background Mental health services integrated into primary care is a key strategy for reducing the mental healthcare treatment gap in low- and middle-income countries. We examined trends in healthcare use and costs among individuals with depression and subclinical depressive symptoms in Chitwan, Nepal to understand the impact of integrated care on i...

Background Climate impacts are rarely considered in health impact and economic assessments of public health programs. This study estimates the greenhouse gas (GHG) emissions averted by a novel oral SARS-CoV-2 (COVID-19) vaccine compared with four existing intramuscular vaccines: AstraZeneca's COVISHIELD®, Pfizer/BioNTech's COMIRNATY®, Moderna's mRN...

Disruptions in routine immunization caused by COVID-19 put African countries with large vaccine-preventable disease burdens at high risk of outbreaks. Abbas et al. (2020) showed that mortality reduction from resuming immunization outweighs excess mortality from COVID-19 caused by exposure during immunization activities. We leverage these estimates...

Background Value of a Statistical Life Year (VSLY) provides an important economic measure of an individual’s trade-off between health risks and other consumption, and is a widely used policy parameter. Measuring VSLY is complex though, especially in low-income and low-literacy communities. Methods Using a large randomized experiment (N = 3027), we...

Understanding how well a health system is meeting the needs of the population is critical to achieving the policy aspirations of universal health coverage. This study focuses on assessing the inequity of forgone care for priority maternal and child health services across India. We utilize data from the 4th round of the Indian National Family Health...

Background India has made substantial progress in improving child health in recent years. However, the country continues to account for a large number of vaccine preventable child deaths. We estimated wealth-related full immunization inequalities in India. We also calculated the degree to which predisposing, reinforcing, and enabling factors contri...

Background: Diarrhea is a leading cause of morbidity and mortality among the under-five children in Bangladesh. Hospitalization for diarrhea can pose a significant burden to the households and health-systems. We aim to estimate the cost-of-illness due to diarrhea from the healthcare facility, caregiver, and societal perspectives in Bangladesh. Me...

Background There were about 138 million new episodes of pneumonia and 0.9 million deaths globally in 2015. In Uganda, pneumonia was the fourth leading cause of death in children under five years of age in 2017-18. However, the economic burden of pneumonia, particularly for households and caregivers, is poorly documented. Aim To estimate the costs...

This paper utilizes causal time-series and panel techniques to examine the relationship between development assistance for health (DAH) and domestic health spending, both public and private, in 134 countries between 2000 and 2015. Data on 237 656 donor transactions from the Institute for Health Metrics and Evaluation's DAH and Health Expenditure da...

Objectives The contingent valuation (CV) method elicits WTP for calculating the value of statistical life (VSL). CV approaches for assessing VSL are uncommon in many low and middle-income countries (LMICs). Between 2008 and 2018 only 44 articles utilized WTP in a health-related field and of these only 5 (11%) utilized CV to assess the WTP for a mor...

Background: There is very limited evidence about the economic cost of measles in low-income countries. We estimated the cost of treating measles in Uganda from a societal perspective. Methods: We conducted an incidence-based cost-of-illness study in Uganda. We surveyed the facility staff, recording hospital-related expenditures for measles patient...

Background This study estimated the economic cost of treating measles in children under-5 in Bangladesh from the caregiver, government, and societal perspectives. Method We conducted an incidence-based study using an ingredient-based approach. We surveyed the administrative staff and the healthcare professionals at the facilities, recording their...

Background Serosurveys are a valuable surveillance tool because they provide a more direct measure of population immunity to infectious diseases, such as measles and rubella, than vaccination coverage estimates. However, there is concern that serological surveys are costly. We adapted a framework to capture the costs associated with conducting a se...

Objectives Understanding the level of investment needed for the 2021-2030 decade is important as the global community faces the next strategic period for vaccines and immunization programs. To assist with this goal, we estimated the aggregate costs of immunization programs for ten vaccines in 94 low- and middle-income countries from 2011 to 2030....

Objectives Vaccination has prevented millions of deaths and cases of disease in low- and middle-income countries (LMICs). During the Decade of Vaccines (2011-2020), international organizations, including the World Health Organization and Gavi, the Vaccine Alliance, focused on new vaccine introduction and expanded coverage of existing vaccines. As G...

Background Cost-of-illness data from empirical studies provide insights into the use of healthcare resources including both expenditures and the opportunity cost related to receiving treatment.Objective The objective of this systematic review was to gather cost data and relevant parameters for hepatitis B, pneumonia, meningitis, encephalitis caused...

Estimating the value of global investment in immunization programs is critical to helping decision makers plan and mobilize immunization programs and allocate resources required to realize their full benefits. We estimated economic benefits using cost-of-illness and value-of-a-statistical-life approaches and combined this estimation with immunizati...

Background: This study estimated the economic cost of treating measles in children under-5 in Bangladesh from the caregiver, government, and societal perspectives. Method: We conducted an incidence-based study using an ingredient-based approach. We surveyed the administrative staff and the healthcare professionals at the facilities, recording their...

Background: This study estimated the economic cost of treating measles in children under-5 in Bangladesh from the caregiver, government, and societal perspectives. Method: We conducted an incidence-based study using an ingredient-based approach. We surveyed the administrative staff and the healthcare professionals at the facilities, recording their...

Background: This study estimated the economic cost of treating measles in children under-5 in Bangladesh from the caregiver, government, and societal perspectives. Method: We conducted an incidence-based study using an ingredient-based approach. We surveyed the administrative staff and the healthcare professionals at the facilities, recording their...

Objective To explore the socioeconomic factors associated with epilepsy in the Republic of Guinea. Methods People living with epilepsy (PLWE) were prospectively recruited at Ignace Deen Hospital, Conakry, in 2018. An instrument exploring household assets as a measure of wealth was designed and administered. Multivariate logistic regression models...

Following publication of the original article [1], the authors flagged an error in Addition file 6.

Background: The value of a statistical life-year (VSLY) is the central number for the economic allocation of health resources. Nevertheless, empirical data on VSLY are lacking for most low- and middle- income countries. In the absence of empirically established VSLY, researchers typically use an arbitrary 3-times multiple of per-capita gross domes...

Background: In low-income countries (LICs), there are multiple barriers for children with epilepsy (CWE) to attend school. We examined potentially modifiable associations with poor school performance in CWE in the West African Republic of Guinea. Methods: Children with epilepsy of school age were recruited using public announcements and a clinic...

The DOVE study assesses the cost of illness for pneumonia, diarrhea and measles in children <5 for the healthcare system and their household in Uganda and Bangladesh. The study collects cost, expenditure and utilization data from facility records, facility staff interviews, district government records and caregiver interviews. Caregivers are interv...

Collecting cost and utilization data from caregivers and healthcare facilities proves challenging. Researchers face the threat of inaccessible or unreliable/inaccurate data. Economic evaluations hardly seem relevant to the practice of physicians and nurses, and inaccessible for district health officers and agents who could see use for it.

Objectives: The purpose of this research is to understand the thought processes that underpin responses to stated preference approaches for eliciting quality of life, in particular the standard gamble. Methods: We utilize standard gamble preference elicitation survey techniques to elicit quality-adjusted life year weights for two reduced health...

Background: We characterize the variations in availability and affordability of NMO diagnostic testing and treatment by geographic region and country-level income group. Methods: A structured survey was distributed in English, French, and Spanish in late 2018 to neurologists and other physicians who encounter NMO patients. Results: Respondents...

How do different professional structures shape the economic ideas that international economic organizations use to prescribe policy recommendations or derive legitimacy and authority for them? The comparative professional field analysis proposed herein deploys a novel combination of content, network and regression analysis to uncover the precise ro...

Background Benefit Incidence Analysis (BIA) is used to understand the distribution of health care utilization and spending in comparison to income distribution. The results can illustrate how effectively governments allocate limited resources towards meeting the needs of the poor. In analyzing the distribution of public spending on inpatient, outpa...

Background Food assistance interventions directed at households may miss undernourished individuals if intra-household equity in nutrient allocation is assumed. A recent study from Ethiopia revealed that, while all age groups consumed calories in proportion to their fair share, iron and protein were inequitably allocated among household members. Fu...

Background: The transmission of malaria through population inflows from highly endemic areas with limited control efforts poses major challenges for national malaria control programmes. Several multilateral programmes have been launched in recent years to address cross-border transmission. This study assesses the potential impact of such a program...

While evidence suggests that adequate nutrition contributes to the efficacy of antiretroviral therapy (ART), the potential causal impact of ART initiation itself on household food security has not been thoroughly examined. In this study, we present some of the first causal evidence of the impact of ART initiation on household food security. We empl...

Quality of life is a pragmatic endpoint for understanding the experience of people with epilepsy (PWE) in low- and middle-income countries (LMICs), where > 80% of PWE reside. However, the literature is bereft of QOL in epilepsy (QOLIE) studies among LMICs and knowledge of the variation in QOLIE globally. We therefore performed a Medline search of o...

Objective: The aim of this study was to assess medication prescribing and patient-reported outcomes among people with epilepsy (PWE) in Bhutan and introduce criteria for evaluating unmet epilepsy care needs, particularly in resource-limited settings. Methods: People with epilepsy in Bhutan (National Referral Hospital, 2014-2015) completed a ques...

Objective To assess the knowledge, attitudes and practices of epilepsy among healthcare workers (HCWs) and people with epilepsy (PWE) living in Bhutan. Methods A survey with similar questions was distributed to HCWs and PWE (2014–2015). Responses were compared between the two groups. A Stigma Scale in Epilepsy Score was tested for an independent a...

Purpose: To assess the quality of life in epilepsy (QOLIE) among adults in the lower middle-income country of Bhutan and assess the potential demographic and clinical associations with better QOLIE. Methods: People with clinically diagnosed epilepsy were prospectively enrolled at the Jigme Dorji Wangchuck National Referral Hospital in Thimphu (2...

Objective: To determine the availability, accessibility, and affordability of EEG, EMG, CSF analysis, head CT, and brain MRI for neurologic disorders across countries. Methods: An online, 60-question survey was distributed to neurology practitioners in 2014 to assess the presence, wait time, and cost of each test in private and public health sec...