Funding for childhood immunization totalled US$112·4 billion between 2000 and 2017

Childhood immunization is one of the most cost-effective health interventions. However, despite its known value, global access to vaccines remains far from complete. Although supply-side constraints lead to inadequate vaccine coverage in many health systems, there is no comprehensive analysis of the funding for immunization.

This study aimed to fill this gap by estimating annual immunization spending for 135 low-income and middle-income countries (LMICs) from 2000 to 2017, focusing on government, donor, and out-of-pocket expenditures and disaggregated spending for vaccines and delivery costs, and routine schedules and supplementary campaigns. To generate these estimates, this data from National Health Accounts, the WHO–UNICEF Joint Reporting Forms, comprehensive multi-year plans, databases from Gavi, the Vaccine Alliance, and the Institute for Health Metrics and Evaluation’s 2019 development assistance for health database were extracted. Total spending on immunization was estimated by aggregating the government, donor, prepaid private, and household spending estimates.

This study found that aggregated across all LMICs, government spending consistently remained the largest source of funding, providing between 60·0% (57·7–61·9) and 79·3% (73·8–81·4) of total immunization spending each year (corresponding to between $2·5 billion [2·3–2·8] and $6·4 billion [6·0–7·0] each year). Across income groups, immunization spending per surviving infant was similar in LMICs and territories, with average spending of $40 (38–42) in low-income countries and $42 (39–46) in lower-middle-income countries, in 2017. In addition, In low-income countries and territories, development assistance made up the largest share of total immunization spending (69·4% [64·6–72·0]; $630·2 million) in 2017.