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