Abstract
Background
COVID-19 vaccination pace has declined in many countries during 2022. Reasons for this decrease include reduced perception of risks from less virulent COVID-19 variants, competing health priorities with a refocus on backsliding on childhood immunization, weak health systems limiting delivery capacity, as well as socioeconomic and political factors. For many LMICs with low COVID-19 vaccination coverage, the declining vaccination pace expands projected coverage gaps and estimated financial costs required to close those coverage gaps.
As global health actors accelerate commitments to scale-up COVID-19 vaccine delivery in LMICs, it is important to estimate the costs and the required financial resources, and relate these to projected health financing trends.
Research question
The purpose was to estimate COVID-19 vaccine delivery costs and funding gaps for 133 LMICs to inform global resource mobilization and allocation of COVID-19 vaccination resources between countries.
Objectives
Estimate COVID-19 vaccine delivery costs and financing gap in 133 LMICs
Understand cost drivers of COVID-19 vaccine delivery under different country coverage target scenarios
Draw recommendations for global and country actors financing COVID-19 vaccine delivery and other immunization services
Methods
Estimates were generated using a cost model that contains global and country specific data and parameter assumptions. Input unit cost data were gathered from an intensive scan of the literature on costs of delivery of childhood and adult flu vaccine and recalibrated with data from available country studies that retrospectively assessed delivery costs using primary data collection methods. Country-specific assumptions and predictions on future COVID-19 vaccine delivery scaleup and delivery strategies were based on data and data from national plans where available. For other countries, assumptions and predictions were modelled from globally available data matched to country archetypes. Historical country-specific COVID-19 vaccine absorption rates were used to predict vaccination pace.
Key results
For all 133 countries, total delivery costs ranged between US$ 2.5 billion and US$ 5.6 billion, depending on whether country-defined targets or more ambitious global vaccination targets should be achieved by the end of 2023. Costs of human resource for health, demand generation and vaccination supplies were significant cost drivers across country groups. Costs varied across countries relative to the size of coverage gaps, predominant vaccine delivery method (whether routine or campaign mode), and existing human resource capacity. In the national coverage target scenario, 55 countries were predicted to have a funding gap, amounting to US$ 1.3 billion. In the global target scenario, 101 coverage would have a funding gap, totaling US$ 3.3 billion. In priority countries, the funding gap ranged between 2% and 46% of general government health expenditures. It should be noted that these values were generated in September 2022. At the time of the IHEA conference, the estimates will be updated with new coverage data and external financing available in countries.
Implications for policy and practice
The study enhances our knowledge on financial resources required to scale-up COVID-19 vaccination coverage in LMICs. Recommendations will be drawn for global health financing actors considering available resources for COVID-19 vaccine delivery and global health financing trends