Costs of vaccine programs across 94 low- and middle-income countries

Abstract

While new mechanisms such as advance market commitments and co-financing policies of the GAVI Alliance are allowing low- and middle-income countries to gain access to vaccines faster than ever, understanding the full scope of vaccine program costs is essential to ensure adequate resource mobilization. This costing analysis examines the vaccine costs, supply chain costs, and service delivery costs of immunization programs for routine immunization and for supplemental immunization activities (SIAs) for vaccines related to 18 antigens in 94 countries across the decade, 2011-2020. Vaccine costs were calculated using GAVI price forecasts for GAVI-eligible countries, and assumptions from the PAHO Revolving Fund and UNICEF for middle-income countries not supported by the GAVI Alliance. Vaccine introductions and coverage levels were projected primarily based on GAVI's Adjusted Demand Forecast. Supply chain costs including costs of transportation, storage, and labor were estimated by developing a mechanistic model using data generated by the HERMES discrete event simulation models. Service delivery costs were abstracted from comprehensive multi-year plans for the majority of GAVI-eligible countries and regression analysis was conducted to extrapolate costs to additional countries. The analysis shows that the delivery of the full vaccination program across 94 countries would cost a total of $62 billion (95% uncertainty range: $43-$87 billion) over the decade, including $51 billion ($34-$73 billion) for routine immunization and $11 billion ($7-$17 billion) for SIAs. More than half of these costs stem from service delivery at $34 billion ($21-$51 billion)-with an additional $24 billion ($13-$41 billion) in vaccine costs and $4 billion ($3-$5 billion) in supply chain costs. The findings present the global costs to attain the goals envisioned during the Decade of Vaccines to prevent millions of deaths by 2020 through more equitable access to existing vaccines for people in all communities. By projecting the full costs of immunization programs, our findings may aid to garner greater country and donor commitments toward adequate resource mobilization and efficient allocation. As service delivery costs have increasingly become the main driver of vaccination program costs, it is essential to pay additional consideration to health systems strengthening.

The Equity Impact Vaccines May Have On Averting Deaths And Medical Impoverishment In Developing Countries

“…used estimates of out-of-pocket spending amounts for direct costs (treatment of the disease and transportation) derived from treatment provider costs in previously published literature, 21,[24][25][26][27] and the share of out-of-pocket spending as a percentage of total health spending from the World Bank; 28 and on indirect costs that reflect the forgone earnings associated with care seeking. 29 We defined the latter as the lost income of the main household member due to the time lost for either seeking care or taking a sick child to care (appendix exhibit A8).…”

Current costs & projected financial needs of India′s Universal Immunization Programme

“…A few studies have provided analysis of costing of immunization programmes and cMYPs of GAVI (Global Alliance for Vaccine Initiative) eligible countries89. This study is an attempt to provide information on cMYP costing and to present expenditure on immunization services in India in 2012 and projected costs for five years (2013-2017).…”

Funding gap for immunization across 94 low- and middle-income countries

“…The costing analysis is presented in a companion piece [2]. Specifically, vaccine costs were primarily derived from Gavi, the Pan American Health Organization (PAHO), and UNICEF price projections [10], [11], [12], [13], [14], [15] in combination with doses from Gavi’s Adjusted Demand Forecast version 9 (ADFv9, released spring 2014) [16].…”

“…This analysis augments the Decade of Vaccine Economics (DOVE) project [2], [3], [4], extending prior efforts to examine financing for immunization. Specifically, we explore six scenarios on the impact of future cost and financing projections, link the latest cost and financing requirements at a global scale, examine financing requirements by cost components (vaccine, supply chain, service delivery), and provide uncertainty ranges through sensitivity analyses.…”

“…Specifically, we explore six scenarios on the impact of future cost and financing projections, link the latest cost and financing requirements at a global scale, examine financing requirements by cost components (vaccine, supply chain, service delivery), and provide uncertainty ranges through sensitivity analyses. By linking detailed vaccine program costs [2] with a range of financing projections, this work provides an in-depth view of immunization program resource requirements that reflect dynamic realities such as economic growth and pricing policy changes over time.…”