ThinkWell worked to build country capacity to generate and use cost evidence for sustainable and predictable financing for immunization.
Introduction
As more low- and middle-income countries transition to self-financed immunization programs, country governments need to understand what it will cost to deliver vaccines to reach coverage goals, address health equity, manage the introduce of new vaccines, and achieve efficiencies; however, cost data are often of variable quality and are difficult to access and use by policymakers, program planners, and other global and country-level stakeholders.
Our goal was to help decision-makers access, understand, and use evidence on the cost of delivering vaccines.
The Immunization Costing Action Network (ICAN)
ThinkWell and John Snow Inc. (JSI) supported the Immunization Costing Action Network (ICAN), a research and learning network working to increase the visibility, availability, understanding, and use of immunization delivery cost* information. The ICAN built country capacity to generate cost evidence that is policy relevant and a priority for the immunization program. The ICAN also worked with countries to improve interpretation and translation of cost evidence so that it is used in country decision-making processes and informs routine planning and budgeting. The ICAN believes that when equipped with relevant and user-friendly cost evidence, immunization managers, program planners, and policymakers will be empowered in fundraising and advocacy efforts and will make better resource allocation decisions, improving the efficiency and equity of immunization programs.
The ICAN was supported by the Bill & Melinda Gates Foundation.
SYSTEMATIC REVIEW
ThinkWell completed a systematic review on the cost of delivering vaccines across different low- and middle-income countries and through a variety of vaccine delivery strategies. From the compiled evidence, ThinkWell developed the Immunization Delivery Cost Catalogue (IDCC)―the most comprehensive, current, and standardized global evidence―and companion products to help interpret the evidence.
"The Immunization Delivery Cost Catalogue (IDCC) has been a valuable resource in helping our team locate relevant delivery cost estimates, categorize studies that might be relevant for different vaccines or delivery strategies, and easily understand study characteristics. Our team has used this resource to inform cost-effectiveness analyses of rotavirus vaccination and RSV vaccination across low- and middle-income countries. We have also used the IDCC to inform multiple country-specific studies and provide information from the literature to country decision-makers. In short, the IDCC is a valuable and comprehensive resource for immunization cost information.“
-- Clint Pecenka, PATH’s Center of Vaccine Innovation and Access
COUNTRY RESEARCH & POLICY
The ICAN was comprised of four member countries―India, Indonesia, Tanzania, and Vietnam―with country teams that included health economist researchers, immunization managers, and planners from ministries of health. The country teams conducted costing studies that explored the cost of delivering vaccines through different delivery strategies to diverse geographies and to distinct target populations. ThinkWell and John Snow, Inc. (JSI) facilitated the ICAN to encourage cross-country knowledge sharing and co-production of effective strategies for generation and use of cost evidence.
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*We define immunization delivery costs (IDCs) (also referred to as operational costs) as the costs associated with delivering immunizations to target populations, exclusive of vaccine costs. Delivery costs may include any or all of the following recurrent and capital cost items: (1) paid human resources, (2) volunteer human resources, (3) per diem and travel allowances, (4) cold chain equipment and their overheads (e.g. energy, maintenance, repairs), (5) vehicles, transport and fuel, (6) program management, (7) training and capacity building, (8) social mobilization and advocacy, (9) adverse event following immunization (AEFI) and disease surveillance (i.e. follow up of post-vaccination events and active cases of diseases), (10) buildings, utilities, other overheads and shared costs, (11) vaccine supplies (e.g. safety boxes, diluents, reconstitution syringes), (12) waste management, (13) other supplies and recurrent costs, and (14) other non-vaccine costs.
Using cost evidence for sustainable and predictable financing for immunization
Our analysis resulted in nine delivery unit cost ranges
How to use the most comprehensive, current, standardized global evidence on the cost of delivering vaccines
Building country capacity around the generation and use of cost evidence for immunization
Development of methodological guidance and a costing tool to improve evidence generation on what it costs to conduct an immunization campaign
© 2023, Immunization Costing Action Network (ICAN), ThinkWell, LLC. All rights reserved.