Value of pneumococcal vaccination in controlling the development of antimicrobial resistance (AMR): Case study using DREAMR in Ethiopia

Vaccine. 2021 Oct 29;39(45):6700-6711. doi: 10.1016/j.vaccine.2021.04.024. Epub 2021 Sep 17.


Background: Antimicrobial resistance (AMR) poses an imminent threat to global health security. Pneumococcal vaccination reduces disease incidence, prevents antibiotic use, and decreases antibiotic-resistant infections. However, the benefit of vaccination in reducing AMR has been poorly quantified to date.

Methods: We developed an agent-based model, DREAMR (Dynamic Representation of the Economics of AMR) to evaluate the economic value of childhood immunization with the pneumococcal conjugate vaccine (PCV) in mitigating the development of AMR. Our model incorporates vaccination coverage, disease incidence, care seeking, and antibiotic use. Accumulation of AMR is simulated based on antibiotic exposure through pharmacokinetics and resulting pharmacodynamics. The model was applied to Ethiopia.

Results: Introduction of PCV vaccination has helped slow the development of AMR by 14.77% for amoxicillin and 0.59% for ceftriaxone in Ethiopia since 2011. In addition to the benefit of reduction in disease incidence, PCV vaccination has averted approximately 718,100 antibiotic treatment failures and 9,520 AMR-related deaths (27.8% reduction) in Ethiopia between 2011 and 2017, resulting in savings of $32.7 million. Maintaining current PCV immunization coverage will contribute an additional $7.67 million in annual AMR cost savings over five years compared to no vaccination scenario, which could increase to $11.43 million by increasing PCV coverage to 85% by 2022.

Conclusions: This study is the first to demonstrate the broader economic value of pneumococcal vaccination in controlling the development of AMR in Africa. Vaccination not only saves lives by preventing illnesses, but also benefits society by reducing antibiotic utilization and treatment failures due to AMR.

Keywords: Antimicrobial resistance; Ethiopia; Immunization; Pneumonia; Vaccination.

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Cost-Benefit Analysis
  • Drug Resistance, Bacterial
  • Ethiopia / epidemiology
  • Humans
  • Infant
  • Pneumococcal Infections* / epidemiology
  • Pneumococcal Infections* / prevention & control
  • Pneumococcal Vaccines*
  • Vaccination
  • Vaccines, Conjugate


  • Anti-Bacterial Agents
  • Pneumococcal Vaccines
  • Vaccines, Conjugate