The Immunization Financing resource guide collects 26 brief documents on topics related to the cost and financing of national immunization programs in low- and middle-income countries (LMICs). Some of the briefs explore possible financing sources. Others examine the components and drivers of immunization costs, planning and decision-making processes related to immunization programs and budgets, and the relationship between immunization and broader health system financing. The resource guide concludes with a set of country case studies that illustrate particular approaches or important challenges.
This volume is intended for immunization advocates, program managers, decision-makers, and planners in ministries of health and finance. The information is relevant to countries that are eligible for support from Gavi, the Vaccine Alliance, as well as to countries that are transitioning out of Gavi support and middle-income countries that have never received Gavi support. The briefs can be read in a complete report or individual sections. Each begins with a summary of key points. Some of the briefs are more technical than others, due to their subject matter, but they are all meant to convey practical information to readers who do not have specific technical expertise. Many of the briefs recommend other resources that offer more in-depth information.
The guide is also available in French, Russian, and Spanish.
Immunization ranks among the most cost-effective health interventions, delivering a high ratio of health benefits—lives saved and illness prevented—to cost, especially where the disease burden is high. A recent analysis found that every dollar spent on expanding access to a portfolio of vaccines in LMICs between 2011 and 2020 would return $16 in economic benefits.
Every year, the scope of immunization continues to grow as new vaccines are developed against persistent and emerging diseases, and to adapt to the evolving trends, the governments must plan carefully to ensure adequate and sustainable financing for immunization programs. As an essential first step to understanding the importance of immunization financing, briefs on this part discuss some crucial aspects that have emerged or accelerated in recent years in the global immunization environment.
Access to immunization—and investments in robust immunization services that can serve as a platform for delivering other vital health services— is central to the goal of achieving Universal Health Coverage (UHC). At the same time, immunization planning and budgeting must fit within each country’s health financing architecture as it evolves to meet the UHC goal. Wide variety of alternative financing mechanisms for immunization have been proposed, including trust funds, lotteries, and earmarked taxes, but few have been implemented. Briefs in this part offer general assessments of several innovative funding sources in the context of the movement toward UHC.
Raising resources for immunization is essential, but how funds are spent can also make a big difference. By using funds more efficiently, countries can do more with limited immunization resources. In many cases, the greatest opportunities for gains may come from improved procurement of vaccines because vaccine purchases account for a large share of immunization expenditure, and the prices paid by countries in similar circumstances can vary considerably.
Improvements in how health services, including vaccine delivery, are purchased can also increase the quality and reach of those services by creating a better balance of incentives. Strengthening processes and institutions for immunization decision-making, including making greater use of economic analysis, can also help ensure that funds for immunization yield the greatest possible health and economic benefits. Briefs in this section depict the options in public financial management that are critical to efficient financing of all health programs.
General government revenues, supplemented where relevant by social insurance contributions and donor financing, will remain the financial backbone of most countries’ health and immunization programs. These traditional public financing systems are typically the most equitable and sustainable, and they are managed through existing public financial management systems. However, overseeing and financing immunization programs is a natural responsibility of governments. The pursuit of secondary funding should not distract governments and advocates from ensuring adequate and sustainable allocations from the general health budget both for immunization and the broader health service delivery platform on which it depends. Briefs in this section discuss several political strategies for strengthening immunization financing.
In planning the financing of immunization programs, governments face both immense opportunities and fundamental challenges. Not all vaccines are appropriate in all settings, and in deciding whether to introduce a new vaccine, governments must consider factors including local disease burden, vaccine safety and effectiveness, and the costs of the vaccine and its delivery. Moreover, they must weigh the potential benefits of the vaccine against those of other uses of scarce resources. The following briefs show the lessons learned from several countries that have succeeded in sustaining immunization financing.
