Group A Streptococcus (Strep A) is the fifth leading cause of infectious disease deaths globally. In addition, Strep A is responsible for perhaps the widest array of disease manifestations of any pathogen (ranging from superficial skin and throat infections to rheumatic heart disease), frequent outpatient visits to healthcare facilities in high-income countries (HICs), and a substantial amount of antibiotic consumption. Overall, the burdens of Strep A fall disproportionately on low- and middle-income countries and on disadvantaged groups (such as indigenous communities) in HICs.
Effective and relatively inexpensive treatment for Strep A diseases exists in the form of penicillin. However, access to care and treatment is often inadequate for the most-vulnerable populations, and overreliance on treatment may have significant drawbacks, including microbiome disruption and increased antibiotic resistance in bystander pathogens. Several promising vaccine candidates for Strep A are in early development, but funding for large-scale clinical trials has not been forthcoming. This situation suggests that the value of Strep A vaccines may be in question; investigation of the full societal value of Strep A vaccination is therefore warranted.
This paper builds off recent work dedicated to conceptualizing the full range of health, economic, and social benefits yielded by vaccination, beyond direct reductions in morbidity, mortality, and future healthcare costs typically considered in economic analyses. We begin by briefly reviewing recent developments in this area of research before defining a general valuation framework for vaccination. We then discuss application of that framework to prospective Strep A vaccines. We also identify a subset of Strep A vaccination benefits that merit formal quantification.