title: Funding gap for immunization across 94 low- and middle-income countries.
abstract: Novel vaccine development and production has given rise to a growing number of vaccines that can prevent disease and save lives. In order to realize these health benefits, it is essential to ensure adequate immunization financing to enable equitable access to vaccines for people in all communities. This analysis estimates the full immunization program costs, projected available financing, and resulting funding gap for 94 low- and middle-income countries over five years (2016-2020). Vaccine program financing by country governments, Gavi, and other development partners was forecasted for vaccine, supply chain, and service delivery, based on an analysis of comprehensive multi-year plans together with a series of scenario and sensitivity analyses. Findings indicate that delivery of full vaccination programs across 94 countries would result in a total funding gap of $7.6 billion (95% uncertainty range: $4.6-$11.8 billion) over 2016-2020, with the bulk (98%) of the resources required for routine immunization programs. More than half (65%) of the resources to meet this funding gap are required for service delivery at $5.0 billion ($2.7-$8.4 billion) with an additional $1.1 billion ($0.9-$2.7 billion) needed for vaccines and $1.5 billion ($1.1-$2.0 billion) for supply chain. When viewed as a percentage of total projected costs, the funding gap represents 66% of projected supply chain costs, 30% of service delivery costs, and 9% of vaccine costs. On average, this funding gap corresponds to 0.2% of general government expenditures and 2.3% of government health expenditures. These results suggest greater need for country and donor resource mobilization and funding allocation for immunizations. Both service delivery and supply chain are important areas for further resource mobilization. Further research on the impact of advances in service delivery technology and reductions in vaccine prices beyond this decade would be important for efficient investment decisions for immunization.
authors.affiliation: Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA. Electronic address: ozawa@unc.edu.
authors.forename: Sachiko
authors.initials: S
authors.lastname: Ozawa
authors.affiliation: Department of Pharmacy, University of Washington, Seattle, WA, USA.
authors.forename: Simrun
authors.initials: S
authors.lastname: Grewal
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Portnoy
authors.affiliation: Department of Preventive Medicine and Community Health, New Jersey Medical School, Rutgers University, Newark, NJ, USA.
authors.forename: Anushua
authors.initials: A
authors.lastname: Sinha
authors.affiliation: Department of Preventive Medicine and Community Health, New Jersey Medical School, Rutgers University, Newark, NJ, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Arilotta
authors.affiliation: Independent Consultant, Denver, CO, USA.
authors.forename: Meghan L
authors.initials: ML
authors.lastname: Stack
authors.affiliation: Bill and Melinda Gates Foundation, Washington, DC, USA.
authors.forename: Logan
authors.initials: L
authors.lastname: Brenzel
mesh_terms: D002202:Capital Financing; D003906:Developing Countries; D006801:Humans; D007114:Immunization / Q000191:economics* / Q000706:statistics & numerical data*; D017589:Immunization Programs / Q000191:economics*
keywords: Financing; Funding gap; Immunization; Low- and middle-income country; Vaccine