ThinkWell is conducting costing studies of COVID-19 vaccine delivery in Bangladesh, Côte d’Ivoire, the Democratic Republic of the Congo (DRC), Mozambique, the Philippines, Uganda, and Vietnam to generate economic evidence to the support the sustainable roll-out of COVID-19 vaccines.
The delivery of COVID-19 vaccines posed unprecedented challenges in terms of delivery volume and reaching new target populations. Meanwhile, what it costs to deliver these vaccines remains highly uncertain. To support government in planning and budgeting for the COVID-19 vaccination programs, ThinkWell is conducting vaccine delivery costing studies in 7 low- and middle-income countries.
In each country, bottom-up ingredients-based costing studies are being conducted to estimate the cost of delivering COVID-19 vaccines through various delivery strategies, reaching different target populations, and using products with varying cold chain requirements. The studies are also mapping out the service delivery process and funding flows, and capturing the source and use of different types of paid and volunteer health workers mobilized to deliver COVID-19 vaccines. Semi structured interviews are being conducted with stakeholders to assess the roll-out and its challenges.
ThinkWell also contributed to a global-level modeling of COVID-19 vaccine delivery costs in COVAX countries.
ThinkWell and Ndejje University are working directly and in close partnership with Kampala Capital City Authority (KCCA) to estimate the cost of delivering COVID-19 vaccines in the urban capital in 2021. The study examines the initial vaccination rollout period between March and June 2021 when priority populations were targeted, and the higher–volume period between July and December 2021 when the target population was extended to the general population. Through an extensive capacity-strengthening approach, KCCA has been directly engaged in supporting tool development, data collection, analysis, and continuous validation. A dissemination meeting was held at the end of January 2024 with key stakeholders and the study report will be published soon.
In collaboration with the national immunization program, ThinkWell and the Kinshasa School of Public Health estimated the cost of delivering COVID-19 vaccines in the Democratic Republic of the Congo (DRC) through routine and campaign delivery between April and June 2022. The rollout in the DRC was characterized by very high vaccine hesitancy, inadequate cold chain equipment and transport, low motivation among health workers due to lack of payments, and an insufficient number of vaccination sites. This meant that by the time of data collection, only 4% of the population had received at least one dose of the vaccine. Despite the extreme lack of resources, the financial cost per dose delivered was high (US$3.12 for routine and $1.91 for campaigns) due to the very low volume delivered.
In Bangladesh, ThinkWell and the Institute for Health Economics (IHE) worked closely with the Expanded Program on Immunization (EPI) to estimate the cost of delivering and receiving COVID-19 vaccines for fixed and temporary site delivery modalities between February 2021 and November 2022. Bangladesh managed to achieve high coverage rapidly at a much lower cost per dose than other countries, thanks to the large number of doses that vaccination sites managed to deliver daily, and the trust in and robustness of the EPI program’s infrastructure.
The financial cost varied greatly across strategies—from US$0.29 at Ministry of Health hospitals to $0.44 at outreach EPI centers. We also found that beneficiaries spent an average of $1.63 to receive one dose of COVID-19 at urban fixed sites. Assumptions and findings were validated through a series of workshops at the local and national level, and the results were disseminated with the Ministry of Health and partners at the national event in Dhaka.
ThinkWell and the Ateneo School of Medicine and Public Health conducted a costing study on the delivery of COVID-19 vaccines at public and private sites during a mass vaccination campaign in November and December 2021 and period of routine style delivery from May to July 2022. The financial delivery cost varied across the different types of delivery sites from US$0.90-$1.79 per dose delivered during the campaign and $2.06-$3.53 during the later routine-style period. This is higher than what was found in other countries, primarily due to additional hiring of health workers at a level not observed elsewhere.
In partnership with the immunization program at the Ministry of Health, ThinkWell worked with the University Eduardo Mondlane (UEM) to estimate the cost of delivering COVID-19 vaccines in Mozambique during the start of the rollout in March and April 2021, and a later high-volume phase of December 2021 to February 2022. We found that the cost per dose decreased dramatically as delivery volume ramped up, from an economic cost of US$3.56 per dose to $0.85 per dose. Despite the lack of additional resources—reflected in a financial cost per dose dipping as low as $0.43 during the high-volume period—Mozambique achieved high coverage thanks to political prioritization and the commitment of existing health workers. However, as no additional health workers were hired for COVID-19 vaccination, this likely impacted the provision of other health services.
ThinkWell worked with the Hanoi University of Public Health in Vietnam to estimate the cost of delivering COVID-19 vaccines in 2021. The financial cost was found to be low at US$0.59 per dose delivered, though this masked shortages in staffing and other resources that the vaccination program had to work around. Limited investments to expand capacity for the rollout meant that a significant burden was placed on the existing health system resources.
In Côte d’Ivoire, Genesis Analytics and ThinkWell implemented a costing study, with a team from Université Felix Houphouet Boigny, to collect data on the cost of delivering COVID-19 vaccines from March to May 2022. The study found a relatively low financial cost for delivering vaccines in 2022 (US$0.67 per dose delivered) which likely reflected a lack of funding rather than low financial requirements to support vaccination. The higher economic cost ($3.16 per dose delivered) highlights the important role of both existing paid staff as well as volunteers.
The protocol discusses the studies’ scope and methods, and expected outputs. While recognizing that the diverse range of vaccine roll-out modalities will require tailored research approaches in each of the countries, this general research protocol is aimed at ensuring comparability across countries and facilitating cross-country learnings.
Preliminary results were presented at the International Health Economics Association (IHEA) 2023 Immunization Economics Pre-Congress in July 2023, and final results will be published following the publication of all individual country studies.
ThinkWell contributed to a global-level modeling of COVID-19 vaccine delivery costs released by the COVAX Readiness and Delivery Working Group on Delivery Costing, authored by experts from UNICEF, Bill & Melinda Gates Foundation, Dalberg, and the Harvard T. H. Chan School of Public Health.
This reported estimated the cost of delivering COVID-19 vaccines to 70% of target populations in 133 low- and middle-income countries. The analysis also estimated the financing gap between the predicted delivery costs and external financing commitments for COVID-19 vaccine delivery across the 133 countries (not including information on government or domestic resources).
