title: Costs of introducing pneumococcal, rotavirus and a second dose of measles vaccine into the Zambian immunisation programme: Are expansions sustainable?
abstract: Introduction of new vaccines in low- and lower middle-income countries has accelerated since Gavi, the Vaccine Alliance was established in 2000. This study sought to (i) estimate the costs of introducing pneumococcal conjugate vaccine, rotavirus vaccine and a second dose of measles vaccine in Zambia; and (ii) assess affordability of the new vaccines in relation to Gavi's co-financing and eligibility policies.
  
  
  
  Data on 'one-time' costs of cold storage expansions, training and social mobilisation were collected from the government and development partners. A detailed economic cost study of routine immunisation based on a representative sample of 51 health facilities provided information on labour and vaccine transport costs. Gavi co-financing payments and immunisation programme costs were projected until 2022 when Zambia is expected to transition from Gavi support. The ability of Zambia to self-finance both new and traditional vaccines was assessed by comparing these with projected government health expenditures.
  
  
  
  'One-time' costs of introducing the three vaccines amounted to US$ 0.28 per capita. The new vaccines increased annual immunisation programme costs by 38%, resulting in economic cost per fully immunised child of US$ 102. Co-financing payments on average increased by 10% during 2008-2017, but must increase 49% annually between 2017 and 2022. In 2014, the government spent approximately 6% of its health expenditures on immunisation. Assuming no real budget increases, immunisation would account for around 10% in 2022. Vaccines represented 1% of government, non-personnel expenditures for health in 2014, and would be 6% in 2022, assuming no real budget increases.
  
  
  
  While the introduction of new vaccines is justified by expected positive health impacts, long-term affordability will be challenging in light of the current economic climate in Zambia. The government needs to both allocate more resources to the health sector and seek efficiency gains within service provision.
authors.affiliation: Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom. Electronic address: ulla.griffiths@lshtm.ac.uk.
authors.forename: Ulla Kou
authors.initials: UK
authors.lastname: Griffiths
authors.affiliation: Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
authors.forename: Fiammetta Maria
authors.initials: FM
authors.lastname: Bozzani
authors.affiliation: World Bank, Zambia Country Office, Banc ABC House, Church Road, Lusaka, Zambia.
authors.forename: Collins
authors.initials: C
authors.lastname: Chansa
authors.affiliation: Perinatal Health Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Soweto, South Africa.
authors.forename: Anthony
authors.initials: A
authors.lastname: Kinghorn
authors.affiliation: World Health Organization, Lusaka, Zambia.
authors.forename: Penelope
authors.initials: P
authors.lastname: Kalesha-Masumbu
authors.affiliation: Center for Infectious Disease Research in Zambia (CIDRZ), Plot 5032 Great North Road, Lusaka, Zambia.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Rudd
authors.affiliation: Center for Infectious Disease Research in Zambia (CIDRZ), Plot 5032 Great North Road, Lusaka, Zambia.
authors.forename: Roma
authors.initials: R
authors.lastname: Chilengi
authors.affiliation: Bill and Melinda Gates Foundation, 1300 I Street, NW Suite 200, Washington, DC, United States.
authors.forename: Logan
authors.initials: L
authors.lastname: Brenzel
authors.affiliation: Strategic Development Consulting (SDC), Pietermaritzburg, South Africa.
authors.forename: Carl
authors.initials: C
authors.lastname: Schutte
mesh_terms: D002648:Child; D003365:Costs and Cost Analysis; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D008458:Measles Vaccine / Q000191:economics*; D022242:Pneumococcal Vaccines / Q000191:economics*; D022243:Rotavirus Vaccines / Q000191:economics*; D018074:Vaccines, Conjugate / Q000191:economics; D015024:Zambia
chemical_list: D008458:Measles Vaccine; D022242:Pneumococcal Vaccines; D022243:Rotavirus Vaccines; D018074:Vaccines, Conjugate
keywords: Affordability; Costs; Financing; Gavi; Vaccines