Elsevier

Vaccine

Volume 33, Supplement 1, 7 May 2015, Pages A99-A108
Vaccine

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

https://doi.org/10.1016/j.vaccine.2014.12.037Get rights and content

Highlights

  • Vaccine programs cost $62 billion across 94 countries in this decade (2011–2020).

  • More than half of vaccine program costs are in service delivery (55%, $34 billion).

  • Cost per program dose range from $2.2 to $3.5 by country income groupings.

  • Updatable model estimates vaccine, supply chain, and service delivery costs of immunization.

  • Useful for global resource mobilization related to global vaccine action plan.

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.

Introduction

This decade (2011–2020) has been labeled “the Decade of Vaccines” after various country governments and international donors committed to help discover, develop, and deliver vaccines to people in the world's poorest countries. Understanding the full scope of vaccination program costs is vital to ensuring adequate resource mobilization to attain the goals envisioned by the Decade of Vaccines Collaboration. This costing analysis responds to the requests of the World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) as part of the Decade of Vaccines Economics (DOVE) project to strengthen methods for estimating and projecting immunization program resource requirements [1]. While the study builds on lessons learned from previous costing exercises, it extends beyond prior efforts by transparently modeling more detailed cost components (vaccine, supply chain, service delivery), exploring enhanced model methods, and providing sensitivity and scenario analyses. By taking a bottom-up approach to cost each component, this analysis identifies specific cost drivers of immunization programs. The aim of this paper is to detail the model structure, input sources, modeling methods, and baseline results of vaccination program costs.

Section snippets

Analysis scope

The costing analysis focused on 94 low- and middle-income countries identified by the global vaccine action plan (GVAP) and country eligibility policy of the GAVI Alliance across the Decade of Vaccines, 2011–2020. The GVAP, endorsed by 194 Member States at the World Health Assembly in 2012, centered around low- and middle-income countries that currently or have previously received support from the GAVI Alliance [2]. Based on current GAVI classifications, the 94 countries include 36 low-income

Results

The total cost of the full vaccination program across 94 low- and middle-income countries is projected to be US$61.9 billion (95% uncertainty range: $42.7–$87.4 billion) from 2011 to 2020. More than half (55%) of this expected cost is for service delivery, including costs for program management, training, social mobilization, and surveillance. An additional 38% relates to vaccine and injection supplies and the remainder (7%) represents supply chain costs. Fig. 2 presents the routine and

Discussion

This costing analysis adds to the international knowledge base by estimating the global costs to reach the GVAP goals across the Decade of Vaccines. By projecting the full costs of immunization programs, our findings may aid to garner greater country and donor commitments toward preventing millions of deaths by 2020 through more equitable access to existing vaccines for people in all communities. Beyond the aggregate cost estimates, costs associated with vaccines, supply chain, and service

Authorship

AP, SO, and SG designed the study, developed the methodology, collected the data, performed the analysis, and wrote the manuscript. For the supply chain component, BAN, JR, KMG, LAH, STB, and BYL developed the methodology, collected the data, and performed the analysis. All authors contributed to critical revision of the manuscript and have approved the final article.

Sources of support

This study was performed with financial support from the Bill & Melinda Gates Foundation (Contract # 23120). The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Bill & Melinda Gates Foundation.

Conflicts of interest

None.

Acknowledgements

We thank the GVAP Costing and Financing Steering Committee (Logan Brenzel, Thomas Cherian, Santiago Cornejo, Gian Gandhi, Hope Johnson, Thomas O’Connell, Claudio Politi, and Damian Walker) for guidance of this research. We also thank Jason Roffenbender for support in service delivery cost analysis and Anushua Sinha, Meghan Stack, and Richard Arilotta for their valuable comments.

References (45)

  • GAVI Alliance

    Adjusted demand forecast version 9.0

    (2014)
  • World Health Organization

    Global measles and rubella strategic plan 2012–2020

    (2012)
  • Global Polio Eradication Initiative (GPEI)

    Financial resource requirements 2013–2018

    (2013)
  • GAVI Alliance

    Vaccine introduction grants and operational support for campaigns policy

    (2012)
  • GAVI Alliance

    GAVI vaccine price forecasts

    (2013)
  • GAVI Alliance

    Country ceilings and 5-year budget breakdown for country applications submitted in 2013

    (2013)
  • GAVI Alliance

    All countries commitments and disbursements

    (2014)
  • GAVI Alliance

    Country ceilings and maximum annual amounts for budgeting for GAVI Health Systems Strengthening (HSS) grant applications submitted in 2014

    (2014)
  • PAHO Revolving Fund

    Expanded program of immunization vaccine prices for year 2011

    (2011)
  • PAHO Revolving Fund

    Expanded program of immunization vaccine prices for year 2012

    (2012)
  • PAHO Revolving Fund

    Expanded program of immunization vaccine prices for year 2013

    (2013)
  • PAHO Revolving Fund

    Expanded program of immunization vaccine prices for year 2014

    (2014)
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