ABSTRACT
Background: Childhood immunization is one of the most cost-effective health interventions available. Nonetheless, access to key vaccines remains far from complete. The Global Vaccine Action Plan (GVAP) 2011-2020 and the Immunization Agenda 2030 (IA2030) have intended to catalyze progress towards universal coverage for key vaccines. Despite these goals, comprehensive estimates of domestic spending on immunization do not exist, and there is very limited data on domestic private spending on immunization. This research aims to fill this gap.
Methods: We estimated annual spending on immunizations for 135 low- and middle-income countries from 2000 through 2017, with a focus on government, donor, and out-of-pocket spending, and disaggregated spending for vaccines, delivery costs, routine immunization schedules and supplementary campaigns. To generate these estimates, we extracted data from National Health Accounts, Joint Reporting Forms, comprehensive Multi Year Plans, Gavi databases and the Institute for Health Metrics and Evaluation’s 2019 development assistance for health database. We estimated total spending on immunization by aggregating the government, donor, pre-paid private and household spending estimates.
Findings: Between 2000 and 2017, funding for immunization totaled $107·6 billion (104·0-113·1). Government spending consistently remained the largest source throughout providing between 58·0% (55·4-59·6) and 79·2% (73·5-81·3) of total immunization spending each year. Across income groups, per surviving infant immunization spending is comparable in low-income and lower middle-income countries, with spending at an average of $40 (38-42) and $40 (37-44) respectively. However, in low-income countries, development assistance makes up the largest share of total immunization spending (69·4% (64·7-71·9)). Overall, we observe higher vaccine coverage associated with increased government spending on immunization although there were countries for which the inverse applied.
Interpretation: While these estimates highlight the immense progress that have been made in the last two decades in increasing spending on immunization and coverage levels, many challenges still remain and require dedication and commitment to ensure that the progress made in the previous decade is sustained and advanced.