The economic cost per dose of delivering COVID-19 vaccines in Mozambique was $0.85, far lower than estimated in other countries

Launched on March 8, 2021, Mozambique’s COVID-19 (C19) vaccine program presented unprecedented challenges in terms of delivery volume and reaching new target populations. Meanwhile, the cost of delivering C19 vaccines remained uncertain. To address this knowledge gap, ThinkWell conducted a retrospective, bottom-up costing study to estimate the financial and economic costs of delivering C19 vaccines in Mozambique.

The costing analysis was complemented by a qualitative assessment of enabling factors and operational challenges from the implementation of the C19 vaccination effort, as well as a mapping of funding flows.

KEY FINDINGS

• During the period of March-April 2021—characterized by a small target population, vaccine supply constraints, and facility-based delivery—the economic cost of delivering one dose of C19 vaccine was US$3.56, while the financial cost per dose was $0.96.

• As volume delivered ramped up—due to expanded target population, easing of supply constraints, and the extensive use of temporary vaccination sites in the community—the cost per dose delivered decreased dramatically. Between December 2021 and February 2022, economic costs dropped to $0.85 per dose, while financial costs went down to $0.43.

• Most financial costs were related to transport (38%) and to vaccine safety and injection supplies (37%).

• Per diem, which are often a cost driver in vaccination campaigns, represented only 7% of the financial cost per dose, and insufficient financial incentives for health workers were flagged as a significant pain point by respondents at all levels of the health system. Moreover, the study found no financial cost related to hiring additional health workers.

• The economic cost per dose—which also includes the value of using existing resources—was driven by salaries of existing health staff (64%). Most economic costs went towards service delivery and social mobilization, while training costs were very low (0.7% of the economic cost per dose) as Mozambique leveraged virtual technologies to conduct trainings down to the district level.

• The cost per dose found by this study is lower than estimates for the delivery of C19 vaccines in other countries: a study in Vietnam found that the economic and financial cost were respectively $5.24 and $2.08 per dose during the initial low-volume period, and $1.65 and $0.56 during the mass vaccination period, while a study in Côte d’Ivoire found that the economic cost per dose was $3.16, while the financial cost was $0.67.

• The economic cost of delivering C19 vaccines during the high-volume period of December 2021 to February 2022 is also lower than existing estimates for vaccination campaigns in Mozambique: a study on the feasibility of an oral cholera mass vaccination campaign estimated the economic cost at $1.53 per dose.

KEY TAKEAWAYS

• The low financial cost per dose found in the study reflects the inadequacy of available resources: although donors and partners supported key areas of the vaccination effort, funding still fell short and delays in disbursements and release of funds disrupted program implementation.

• Despite the significant resource constraints, Mozambique achieved high vaccination coverage thanks to political prioritization and the dedication of health workers.

• However, as no additional health workers were hired to carry out C19 vaccination, the pressure to achieve high vaccination coverage within a short period of time likely impacted the provision of other health services.

• Our study found a higher cost per dose during the initial low-volume phase, when a small priority group was targeted, suggesting a need to rethink delivery strategies to ensure cost-efficiency in future implementation phases.

This study is part of a multi-country project that utilizes standardized methods to generate cost evidence on the delivery of C19 vaccines in low- and middle-income countries. The project is led by ThinkWell, and supported by the Bill & Melinda Gates Foundation, and covers studies in Côte d’Ivoire, the Democratic Republic of Congo, Mozambique, Uganda, Vietnam, Bangladesh, and the Philippines.