Costs of vaccine programs across 94 low- and middle-income countries.
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.
International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 855 N. Wolfe St., Suite 600, Baltimore, MD 21205, USA. Electronic address: aportnoy@jhu.edu.
Allison
A
Portnoy
International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 855 N. Wolfe St., Suite 600, Baltimore, MD 21205, USA. Electronic address: ozawa@jhu.edu.
Sachiko
S
Ozawa
International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 855 N. Wolfe St., Suite 600, Baltimore, MD 21205, USA. Electronic address: simrun.grewal@gmail.com.
Simrun
S
Grewal
Department of Industrial Engineering, University of Pittsburgh, 1033 Benedum Hall, Pittsburgh, PA 15261, USA. Electronic address: banorman@pitt.edu.
Bryan A
BA
Norman
Department of Industrial Engineering, University of Pittsburgh, 1039 Benedum Hall, Pittsburgh, PA 15261, USA. Electronic address: rajgopal@pitt.edu.
Jayant
J
Rajgopal
International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 855 N. Wolfe St., Suite 600, Baltimore, MD 21205, USA; Public Health Computational and Operational Research (PHICOR) Group, Johns Hopkins Bloomberg, School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA. Electronic address: kgorham3@jhu.edu.
Katrin M
KM
Gorham
Public Health Computational and Operational Research (PHICOR) Group, Johns Hopkins Bloomberg, School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA; Pittsburgh Supercomputing Center (PSC), Carnegie Mellon University, 300 S. Craig St., Pittsburgh, PA 15213, USA. Electronic address: leila@psc.edu.
Leila A
LA
Haidari
Pittsburgh Supercomputing Center (PSC), Carnegie Mellon University, 300 S. Craig St., Pittsburgh, PA 15213, USA. Electronic address: stbrown@psc.edu.
Shawn T
ST
Brown
International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 855 N. Wolfe St., Suite 600, Baltimore, MD 21205, USA; Public Health Computational and Operational Research (PHICOR) Group, Johns Hopkins Bloomberg, School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA. Electronic address: brucelee@jhu.edu.
Bruce Y
BY
Lee
D003906:Developing Countries; D014943:Global Health; D006801:Humans; D017589:Immunization Programs / Q000191:economics* / Q000458:organization & administration; D007223:Infant; D007231:Infant, Newborn; D014611:Vaccination / Q000191:economics*; D014612:Vaccines / Q000008:administration & dosage* / Q000191:economics* / Q000600:supply & distribution
D014612:Vaccines
Costs; Routine immunization; Supplemental immunization activities; Supply chain; Vaccine