Influenza vaccination should have no border: cost-effectiveness of cross-border subsidy

BMC Public Health. 2021 Aug 12;21(1):1543. doi: 10.1186/s12889-021-11601-2.


Background: Influenza is a substantial cause of morbidity and mortality for Israel and the Palestinian territory. Given the extensive interaction between the two populations, vaccination in one population may indirectly benefit the other via reduced transmission. Due to the mobility and extensive contacts, Palestinians employed in Israel could be a prime target for vaccination.

Methods: To evaluate the epidemiological and the economic benefits conferred by vaccinating Palestinians employed in Israel, we developed a model of influenza transmission within and between Israel and the West Bank. We parameterized the contact patterns underlying transmission by conducting a survey among Palestinians employed in Israel, and integrating survey results with traffic patterns and socio-demographic data.

Results: Vaccinating 50% of Palestinian workers is predicted to reduce the annual influenza burden by 28,745 cases (95% CI: 15,031-50,717) and 37.7 deaths (95% CI: 19·9-65·5) for the Israeli population, and by 32,9900 cases (95% CI: 14,379-51,531) and 20.2 deaths (CI 95%: 9·8-31·5) for the Palestinian population. Further, we found that as the indirect protection was so substantial, funding such a vaccination campaign would be cost-saving from the Israeli Ministry of Health perspective.

Conclusions: Offering influenza vaccination to Palestinians employed in Israel could efficiently reduce morbidity and mortality within both Israel and the Palestinian territory.

Keywords: Cost-effective analysis; Influenza vaccination; SIR model; Social contact; Transmission model.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cost-Benefit Analysis
  • Humans
  • Immunization Programs
  • Influenza Vaccines*
  • Influenza, Human* / epidemiology
  • Influenza, Human* / prevention & control
  • Israel / epidemiology
  • Surveys and Questionnaires
  • Vaccination


  • Influenza Vaccines