What have we learned on costs and financing of routine immunization from the comprehensive multi-year plans in GAVI eligible countries?
BACKGROUND
Immunization is one of the most cost-effective health interventions, but as countries introduce new vaccines and scale-up immunization coverage, costs will likely increase. This paper updates estimates of immunization costs and financing based on information from comprehensive multi-year plans (cMYPs) from GAVI-eligible countries during a period when countries planned to introduce a range of new vaccines (2008-2016).


METHODS
The analysis database included information from baseline and 5-year projection years for each country cMYP, resulting in a total sample size of 243 observations. Two-thirds were from African countries. Cost data included personnel, vaccine, injection, transport, training, maintenance, cold chain and other capital investments. Financing from government and external sources was evaluated. All estimates were converted to 2010 US Dollars. Statistical analysis was performed using STATA, and results were population-weighted.


RESULTS
Results pertain to country planning estimates. Average annual routine immunization cost was $62 million. Vaccines continued to be the major cost driver (51%) followed by immunization-specific personnel costs (22%). Non-vaccine delivery costs accounted for almost half of routine program costs (44%). Routine delivery cost per dose averaged $0.61 and the delivery cost per infant was $10. The cost per DTP3 vaccinated child was $27. Routine program costs increased with each new vaccine introduced. Costs accounted for 5% of government health expenditures. Governments accounted for 67% of financing.


CONCLUSIONS
Total and average costs of routine immunization programs are rising as coverage rates increase and new vaccines are introduced. The cost of delivering vaccines is nearly equivalent to the cost of vaccines. Governments are financing greater proportions of the immunization program but there may be limits in resource scarce countries. Price reductions for new vaccines will help reduce costs and the burden of financing. Strategies to improve efficiency in service delivery should be pursued.
Bill & Melinda Gates Foundation, Vaccine Delivery, 4929 Chevy Chase Blvd, Chevy Chase, MD 20815, United States. Electronic address: logan.brenzel@gatesfoundation.org.
Logan
L
Brenzel
D000349:Africa; D002202:Capital Financing / Q000458:organization & administration; D003906:Developing Countries; D006801:Humans; D017589:Immunization Programs / Q000191:economics* / Q000458:organization & administration; D007223:Infant; D007231:Infant, Newborn; D014611:Vaccination / Q000191:economics* / Q000706:statistics & numerical data; D014612:Vaccines / Q000008:administration & dosage* / Q000191:economics* / Q000600:supply & distribution
D014612:Vaccines
Costs; Financing; Low-income; Routine immunization; Sustainability