-->PONE-D-25-66817-->-->Cost analysis of a nationwide typhoid conjugate vaccine campaign in Burkina Faso-->-->PLOS One

Dear Dr. Koulidiati,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.-->--> -->-->Kindly ensure to examine all the comments from the reviewers and provide a point by point responses to their comments.-->--> -->-->Please submit your revised manuscript by Apr 18 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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Leonard Ighodalo Uzairue, PhD

Academic Editor

PLOS One

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When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section.

3. Thank you for stating the following financial disclosure:

“This work was undertaken as part of the Typhoid Vaccine Acceleration Consortium (TyVAC). TyVAC is a partnership between the Center for Vaccine Development and Global Health at the University of Maryland School of Medicine; the Oxford Vaccine Group at the University of Oxford; and PATH, an international nonprofit. This work was supported, in whole or in part, by the Gates Foundation [INV-030857]. Under the grant conditions of the Gates Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission.

J-LK, as an independent consultant and RLZ, DAVYCAS International staff, received consulting fees from PATH.”

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Additional Editor Comments:

Thank you for the study; it is quite an interesting manuscript to read. However, I have some few concerns.

First, there is a need to discuss what 'financial and economic cost' means. You need to bring that in your introduction and also state how it was determined in the method section, because you used it quite a lot in the abstract.

Also, there are inconsistencies in the denominator used, so you need to revisit that and make it consistent.

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Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. -->

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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-->2. Has the statistical analysis been performed appropriately and rigorously? -->

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: I Don't Know

Reviewer #4: Yes

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-->3. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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-->4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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-->5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: Overall assessment

This manuscript makes a strong and timely contribution to the vaccine delivery costing literature by presenting a detailed microcosting analysis of a nationwide typhoid conjugate vaccine (TCV) campaign in Burkina Faso. Large-scale, empirically grounded costing studies of vaccination campaigns—particularly in low-income and insecure settings—remain relatively rare, and this paper substantially advances the evidence base.

The nationwide scope, use of a bottom-up microcosting approach across administrative levels, and explicit attention to cost variation by delivery strategy and security context are major strengths. The study is well aligned with the article’s stated objectives and is highly relevant for immunization program planners and financing partners. Overall, the manuscript is suitable for publication after moderate revisions focused on clarity, transparency, and interpretation, rather than expansion into cost-effectiveness analysis.

Major strengths

1. Substantive contribution through microcosting

The use of a microcosting approach across health facility, district, regional, and national levels is a major strength and the paper’s core contribution. Few published studies capture delivery costs at this level of granularity for a nationwide campaign of this scale. The approach is appropriate, clearly motivated, and well matched to the study objectives.

2. Scale and empirical rigor

The analysis is grounded in a campaign that delivered over 10 million doses, drawing on data from multiple administrative levels. This scale gives the findings strong empirical credibility and makes the resulting unit costs highly policy-relevant. The inclusion of both financial and economic costs further strengthens the analysis.

3. Policy relevance and operational insight

The disaggregation of costs by:

• delivery strategy (fixed, mobile, temporary),

• geography (urban vs. rural),

• and security context

provides actionable insights for campaign design and budgeting. Identifying human resources and per diem payments as dominant cost drivers is consistent with prior campaign experience and reinforces the practical value of the findings.

4. Clear presentation of unit costs

Reporting costs per dose with confidence intervals and benchmarking financial costs against Gavi operational support ranges enhances interpretability and usability for decision-makers. The results are presented clearly and concisely.

Suggestions for improvement

These comments are intended to strengthen transparency and interpretability, not to change the study’s scope.

1. Clarify key microcosting assumptions

The manuscript would benefit from additional detail on:

• How shared or overhead costs (e.g., planning, supervision) were allocated across doses or administrative levels.

• Methods used to annualize capital costs and assumptions about useful life.

• How staff time and opportunity costs were valued for economic cost estimates.

These clarifications could be addressed succinctly in a methods appendix or supplementary table and would improve reproducibility.

2. Expand description of uncertainty estimation

While confidence intervals are reported, the paper should briefly explain:

• The statistical method used to generate them (e.g., bootstrapping, sampling-based variance).

• What sources of uncertainty are captured (sampling only vs. parameter uncertainty).

This would strengthen readers’ confidence in the precision of the estimates.

3. Improve discussion of generalizability

Given the unique security and logistical context of Burkina Faso, the discussion could more explicitly address:

• Which cost components are likely context-specific.

• Which findings (e.g., dominance of HR and per diems) are likely transferable to other low-income settings.

This would help readers appropriately interpret and apply the results elsewhere.

4. Minor clarity and consistency issues

A careful editorial pass could improve:

• Consistency in terminology across sections (e.g., delivery strategy labels).

• Clearer signposting between financial vs. economic cost results.

• Minor typographical and formatting issues.

Conclusion

This is a high-quality costing study that fills an important gap in the literature on vaccine campaign delivery costs. Its primary contribution lies in the depth and rigor of the microcosting analysis, not in extending to cost-effectiveness modeling—and it should be evaluated on those terms. With targeted revisions to improve methodological transparency and discussion, the manuscript will provide a valuable reference for policymakers, donors, and researchers planning future vaccination campaigns.

Reviewer #2: This manuscript presents a technically sound and well-executed cost analysis of a nationwide typhoid conjugate vaccine campaign in Burkina Faso. The retrospective micro-costing approach, conducted from the government perspective across multiple administrative levels; 50 health facilities, 8 districts, 5 regions, and the national level, is appropriate for the study objectives. The data support the conclusions regarding average financial and economic cost per dose, the identification of human resources and per diem payments as key cost drivers, and observed cost variation by geography, delivery strategy, and security context.

The statistical analyses are appropriate and clearly reported, including weighted cost estimates and 95% confidence intervals, with stratified analyses by urban–rural setting and delivery strategy. Ethical approval and informed consent procedures are documented, and data availability is addressed in line with PLOS ONE requirements. Although, minor clarifications may be recommended to harmonize the Data Availability Statement to briefly describe the method used to derive confidence intervals and clarify the potential impact of replacing inaccessible health facilities due to security constraints. Overall, the manuscript meets PLOS ONE’s criteria for publication, and no substantive scientific concerns remain.

Reviewer #3: This manuscript presents a microcosting analysis of Burkina Faso's national typhoid conjugate vaccine (TCV) campaign conducted in January 2025, which reached 10.5 million children aged 9 months to 14 years. The study estimates financial costs at $0.47 per dose and economic costs at $2.16 per dose, demonstrating that campaign delivery costs fall within Gavi operational support ranges. The multi-level sampling approach and stratification by geography, delivery strategy, and security context provide valuable granularity for policy planning.This addresses an important evidence gap, as TCV costing data from francophone Africa are extremely limited despite high typhoid burden. The methodology is generally sound and findings have clear policy relevance for ministries of health, Gavi, and WHO. However, several methodological clarifications and expansions are needed before publication.

Major comments

1. Inconsistent Dose Denominators

Issue: The manuscript reports conflicting total dose numbers:

Abstract and line 197: 10,552,806 doses

Abstract line 38: "10.5 million doses"

Table 2: 11,422,855 doses nationally

Impact: All per-dose cost calculations depend on the correct denominator. This inconsistency undermines confidence in the primary outcome.

Please Reconcile these figures and explain any discrepancy (e.g., incomplete reporting from non-sampled districts)

Use consistent denominator throughout

Recalculate all per-dose costs if necessary

Verify Table 3 calculations align with corrected denominators

2. Uncertainty Quantification Insufficient

Issue: 95% confidence intervals are presented but methodology is not described. No sensitivity analyses are provided despite multiple assumptions (discount rate, volunteer time valuation, vehicle replacement costs, useful life).

I suggest an additional Methods subsection describing CI calculation (bootstrap? parametric assumptions? accounting for clustering?)

Conduct one-way sensitivity analyses on key parameters:

Discount rate (0%, 3%, 5%)

Volunteer wage assumptions

Vehicle/equipment replacement costs

3. Capital Cost Treatment and Shared Infrastructure

Issue: The authors acknowledge excluding "depreciation of long-term infrastructure" (line 309-310) but do not specify which items. It's unclear whether this represents:

Incremental campaign costs only, or

Full economic costs excluding pre-existing infrastructure

Impact: Affects comparability with other studies and interpretation of economic costs.

Specify which capital items were excluded (cold chain equipment? storage facilities? EPI buildings?)

State clearly whether the perspective is incremental campaign cost vs. average cost including shared infrastructure

Justify exclusions based on whether infrastructure was campaign-specific or shared with routine immunization

If feasible, provide sensitivity estimate including shared infrastructure costs.

MINOR CONCERNS

Methods and Reporting

Line 72: Specify which TCV vaccine (Typbar TCV® or TYPHIBEV®) was used in Burkina Faso

Lines 97-98: Standardize terminology as "microcosting" (no hyphen) throughout

Line 120: Describe replacement protocol for 5 inaccessible CSPS more rigorously. What specific matching criteria were used? Conduct sensitivity analysis excluding these sites.

Line 153: Clarify how oral consent was documented

Add to Methods: "Reporting follows CHEERS 2022 guidelines for economic evaluations" and include completed checklist as supplementary file

Reviewer #4: Title: Cost analysis of a nationwide typhoid conjugate vaccine campaign in Burkina Faso

This study is very important in ensuring that scarce resources are judiciously used especially in resource limited country like Burkina Faso.

This is my comment.

The definition of financial cost and economic cost should be included in the introduction because it will give the reader a better understanding of the cost estimate of administering the vaccine in Burkina Faso.

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Reviewer #1: No

Reviewer #2: Yes: Idowu Michael Ariyibi

Reviewer #3: No

Reviewer #4: Yes: Dr Abdulahi Ayanwale

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Attachments

Attachment

Submitted filename: PLOS Article review on Vaccine Burkina Faso.odt

-->PONE-D-25-66817R1-->-->Cost analysis of a nationwide typhoid conjugate vaccine campaign in Burkina Faso-->-->PLOS One

Dear Dr. Koulidiati,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.-->-->

Please submit your revised manuscript by Jun 24 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:-->

• A letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

-->

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

As the corresponding author, your ORCID iD is verified in the submission system and will appear in the published article. PLOS supports the use of ORCID, and we encourage all coauthors to register for an ORCID iD and use it as well. Please encourage your coauthors to verify their ORCID iD within the submission system before final acceptance, as unverified ORCID iDs will not appear in the published article. Only the individual author can complete the verification step; PLOS staff cannot verify ORCID iDs on behalf of authors.

We look forward to receiving your revised manuscript.

Kind regards,

Leonard Ighodalo Uzairue, PhD

Academic Editor

PLOS One

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Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.-->

Reviewer #3: All comments have been addressed

Reviewer #4: All comments have been addressed

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-->2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. -->

Reviewer #3: Yes

Reviewer #4: Yes

**********

-->3. Has the statistical analysis been performed appropriately and rigorously? -->

Reviewer #3: Yes

Reviewer #4: Yes

**********

-->4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->

Reviewer #3: Yes

Reviewer #4: Yes

**********

-->5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #3: Yes

Reviewer #4: Yes

**********

-->6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #3: The authors have substantively improved the manuscript and addressed most prior concerns. Remaining issues are mostly editorial

Reviewer #4: The topic Cost analysis of a nationwide typhoid conjugate vaccine campaign in Burkina Faso.

The issues of definition of some terms were addressed and the define them in the introduction section of the paper.

I believe that the article can be published.

**********

-->7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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Reviewer #3: No

Reviewer #4: No

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

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-->

Attachments

Attachment

Submitted filename: PLOS reviewer.docx

Cost analysis of a nationwide typhoid conjugate vaccine campaign in Burkina Faso

PONE-D-25-66817R2

Dear Koulidiati,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Leonard Ighodalo Uzairue, PhD

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments: