Low volumes, high costs: Delivering COVID-19 vaccines in the Democratic Republic of the Congo

In 2021, when other countries were struggling to obtain sufficient supply of COVID-19 (C19) vaccine doses to meet their population’s demand, the Democratic Republic of the Congo (DRC) suffered from extremely low uptake, primarily due to vaccine hesitancy. Vaccinations were briefly halted following the discovery that 200,000 doses had expired, and the DRC redeployed 1.3M doses received through COVAX to other African countries to avoid more wastage. However, even after global supply increased and DRC endorsed the use of mass campaigns to increase coverage, by August 2022, only 4% of the country’s population had received at least one dose of a C19 vaccine. The program operated with extremely limited resources, with many health facilities lacking powered cold chain and health workers often not receiving their regular salary. As of June 2023, the program had still only attained 7% coverage.

To understand the cost, financing, and operational challenges of the DRC’s C19 vaccination program, the Kinshasa School of Public Health and ThinkWell conducted a retrospective study to estimate the cost of delivering C19 vaccines through routine and campaign delivery in the DRC.

KEY FINDINGS

• Delivery volumes in DRC were very low compared to other C19 vaccination programs in other countries and childhood immunization campaigns—on average 52 doses per site/day during campaigns and only 18 doses per site/day during routine.

• Due to the very low vaccine volumes delivered, the unit cost of delivering C19 vaccines was very high. The financial cost of delivering a C19 vaccine dose across campaigns and routine was on average US$2.18, and the economic cost of delivery was $10.75 per dose.

• The financial and economic costs of delivering a C19 vaccine dose were far higher during routine delivery ($3.12 and $19.56, respectively) than during campaigns ($1.91 and $6.10, respectively), demonstrating that campaigns were able to achieve economies of scale compared with routine delivery.

• Extremely inadequate funding hindered C19 vaccination program implementation in several ways, including inadequate number of vaccination sites to cover the population, inefficiencies due to the lack of cold chain equipment and transport, staff shortages, and even delays in payment of regular salaries.

KEY TAKEAWAYS

• Funding shortages led to inadequate service coverage and inefficient practices, hindering the uptake of the C19 vaccines while the program already struggled with very high vaccine hesitancy.

• Despite the lack of funding, the cost per dose delivered was high due to the very low volume delivered.

• C19 vaccination campaigns were more cost-efficient than routine delivery, reaching more people at a lower cost per dose.

• Committed health workers made the program possible, but without an underlying robust health system and sufficient additional funding, high vaccination coverage remained unattainable.

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 the Congo, Mozambique, Uganda, Vietnam, Bangladesh, and the Philippines.