Date of Award

January 2022

Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Robert Hecht

Second Advisor

David Paltiel


Introduction: The 2018 outbreak of Ebola virus in the Democratic Republic of Congo was the first to occur in the context of an ongoing complex humanitarian emergency. Despite optimism for an effective response given the efficacious one-dose Merck vaccine (ERVEBO), the immense challenges to public health efforts caused by the ongoing armed conflict posed unprecedented complications to the recommended ring vaccination strategy. In the end, contract tracing efforts for ring vaccination reached only 82% of individuals at best estimate, and the outbreak lasted 89 weeks with a total cost of $734 million. In comparison, transmission dynamic modeling has shown the effect that prophylactic vaccination efforts can have on overall epidemic trajectory.

Objective: The objective of this research was to include modeled costs onto the existing data on the impact of prophylactic vaccination to evaluate the cost-effectiveness of large-scale rollout in North Kivu, DRC as a context at significant risk for downstream transmission. For the purposes of cost-effectiveness, the objective was to minimize costs and maximize deaths averted.

Methods: Cost-effectiveness analysis (CEA) using Incremental Cost-Effectiveness Ratios (ICER) was employed to estimate cost per death averted of each of the five strategies evaluated: ring vaccination, 10% and 30% coverage of healthcare workers (HCWs), and an additional 1% and 5% of the general population. Costs for evaluation included vaccination-specific costs and the cost per case and per death, applied to the DRC using World Bank PPP conversion factors.

Results: Ring vaccination was dominated in all analyses run. Prophylactic vaccination was cost-effective in three strategies: 30% coverage of HCWs, + 1% of the general population, or + 5% of the general population. ICER values were found to be $11,899.37 per death averted for 1% coverage or $25,642.30 per death averted at 5% coverage.

Conclusions: Prophylactic vaccination should be strongly considered in areas of Ebola risk.


This thesis is restricted to Yale network users only. It will be made publicly available on 11/19/2022