Low-cost yet expensive: Low financial cost of delivering COVID-19 vaccines in Vietnam masks heavy burden on health staff and disruptions to other services

To support the government in planning and budgeting for the COVID-19 vaccination program, the Hanoi University of Public Health and ThinkWell conducted a study to estimate the cost of delivering COVID-19 vaccines in Vietnam. This was a retrospective, bottom-up costing study that estimated the financial and economic costs incurred in 2021. Data were collected retrospectively by a team from the Hanoi University of Public Health at a sample of 26 immunization sites—including health facilities and temporary sites—as well as at higher administrative level in the provinces of Hanoi and Dak Lak, and from the national-level Ministry of Health and development partners.

Key findings

• The financial cost of delivering C19 vaccines was $0.59 per dose, far below what COVAX estimated ($0.73-1.85). Injection incentives for vaccination team members were the largest financial cost driver (44%), followed by vaccine injection and safety supplies (39%).

• The average economic cost per dose was $1.73, which is less than for the delivery of routine vaccines in Vietnam. Labor-related costs, including salaries of heal

• th staff, unpaid overtime and volunteer labor accounted for 64% of the economic cost per dose.

• Though temporary sites delivered up to 3x as many doses, the financial delivery costs per dose were only 15% lower than for facility-based delivery ($0.56 at temporary sites vs. $0.66 at facilities), and economic costs were higher ($1.78 at temporary sites vs. $1.63 at facilities) driven by much higher volunteer labor costs.

• Delivery costs per dose dropped significantly when delivery volume scaled up, following an expansion of the target population in July 2021. The economic cost per dose dropped from $5.24 in March-June 2021 to $1.65 in July-December 2021.

Key takeaways

• While development partners donated over $12.6 million for the C19 vaccination program in 2021, funding still fell short. The low financial cost reported in this study masks shortages in staffing and other resources that the C19 vaccination program had to work around.

• Limited investments to expand capacity ahead of the roll-out resulted in inefficient vaccine distribution practices, greater recurrent costs, and heavy reliance on existing resources. This placed a significant burden on health workers, and caused disruptions to the delivery of other health services.

• Delivery through temporary sites was very labor-intensive and costly, even during high-volume periods, showing that while this strategy was effective at vaccinating the target population quickly, it cannot be sustainably employed in the long-term.