A new publication from authors from the U.S. Centers for Disease Control and Prevention, CDC Foundation, and Zimbabwe Ministry of Health and Child Care examines the cost of delivering human papillomavirus (HPV) vaccines through a primarily school-based program in Zimbabwe. Zimbabwe introduced the vaccine nationally in 2018 for girls aged 10-14 years through a primarily school-based vaccination campaign. In 2019, a first dose was delivered to a new cohort of girls either in grade five or 10 years of age if out-of-school, along with a second dose to the girls vaccinated in 2018, with a total 1.6 million doses delivered across these cohorts. Researchers conducted an ingredients-based cost analysis from the provider perspective in 2018 and 2019, collecting data at health facility and district levels. The study did not include costs of vaccine introduction activities at the national and provincial levels or procurement of vaccine and vaccination supplies.
Key findings include the following:
The total weighted costs for combined district and health facility administrative levels were US$828,731 (financial) and US$2,060,943 (economic), not including the costs of vaccine and vaccination supplies.
Total weighted cost per dose across all program activities was US$0.53 (financial) and US$1.31 (economic). For the program activity of service delivery alone, the total weighted cost per dose was US$0.16 (financial) and US$0.59 (economic).
The program activities with the largest share of total weighted financial cost were training (37% of total) and service delivery (30%), while the largest shares of total weighted economic costs were service delivery (45%) and training (19%).
Efforts by village health workers to reach out-of-school girls resulted in an additional US$2.99 in financial cost per dose and US$7.79 in economic cost per dose for out-of-school girls.
The service delivery cost per dose was lower than that documented in the pilot program cost analysis in Zimbabwe and studies elsewhere, reflecting a campaign delivery approach that spread fixed costs over a large vaccination cohort. The additional cost of reaching out-of-school girls with the HPV vaccine was documented for the first time in low- and middle-income countries, which may provide information on potential costs for other countries on the additional resources required to make vaccination accessible to all.