3. Policy focused research
3.1 Economic analysis
One of the most important ways of engaging governments in RHD control is demonstrating the economic effects of the disease. In particular, cost effectiveness analysis helps policy makers make evidence based decisions about funding allocations and interventions.
RhEACH is seeking economic analytic partners to undertake a comprehensive cost benefit analysis of comprehensive disease control programs. We hope to develop a model which allows countries or programs to input local burden of disease / cost data to inform decision making. We are contributing to the Trans-Tasman Vaccine Initiative to explore the economic and modelled cost role of vaccine development.
3.2 Endemnicity and elimination
There are no existing definitions/thresholds to classify the burden of RHD. This makes it difficult to classify settings as 'endemic' or 'highly endemic' and to set targets and develop an 'end game' for disease control. Similarly, it's not clear whether it would be possible to completely eliminate RF/RHD with vigorous control methods or a vaccine project. Modelling scenarios for disease control and disease elimination, in vaccine and non-vaccine scenarios could inform goal setting and potentially support advocacy for vaccine introduction.
RhEACH will explore the endemnicity definitions of comparable diseases to identify proposed thresholds for RF/RHD control and functional elimination. Infectious disease modelling will be used to explore control scenarios and estimate the requirements of population level vaccine characteristics.
3.3. A rapid assessment tool for determining RHD burden in individual countries
The only countries with access to reliable RHD burden data are those with population based registers or echocardiographic screening projects. Very few countries have this kind of high quality data and most echocardiographic screening is generally reserved for research activities. Even where reliable prevalence data exists it is rarely translated to disease incidence or burden information useful for advocacy or policy development. Yet there is the potential to draw on existing, routinely collected data to estimate disease burden. RhEACH will coordinate a research project to develop and pilot an RHD assessment for low and middle income settings