The COVID-19 vaccination program was initiated in Kampala, Uganda, in March 2021. As the urban and populous capital city, Kampala rolled out the vaccination program while navigating challenges that differ from other settings in Uganda, including the presence of transient populations and 98% of the health facilities being privately owned. Until now, what it cost to implement the vaccination program in Kampala has remained unknown.
ThinkWell partnered with Kampala Capital City Authority (KCCA) and Ndejje University to estimate the cost of delivering COVID-19 vaccines in Kampala in 2021, the first year of the rollout. Alongside the costing exercise, a qualitative assessment examined how the program was implemented, obtained lessons learned, and mapped key funding flows. The findings can support KCCA with planning and budgeting for immunization programs in the future as well as inform emergency response management.
KEY FINDINGS
- The overall economic cost of COVID-19 vaccination in Kampala in 2021 was estimated at US$7.38 per dose, which includes the vaccine cost. The vaccine delivery cost (excluding vaccines) was $2.33 per dose, comprising of a financial cost of $0.79 per dose and an opportunity cost of $1.54 per dose. Paid labor made up half of the economic cost of delivery. The financial delivery cost was largely driven by injection supplies and allowances.
- Daily delivery volumes of COVID-19 doses per site increased considerably when the target population for COVID-19 vaccination expanded from priority populations to all adults in July 2021. The average doses per day increased from 89 between March and June 2021 (Phase 1) to 149 between July 2021 and December 2021 (Phase 2). The delivery cost per dose in Phase 1 was estimated at $4.16 and decreased significantly to $1.89 when the delivery volume increased in Phase 2.
- There were no significant differences in the cost of delivering through public and private facilities. Costs varied widely between the health facilities that delivered low volumes, regardless of ownership. In the facilities delivering the largest daily volumes (more than 200 doses per day), a lower delivery cost per dose was observed.
- The economic cost of delivering COVID-19 vaccines in Kampala falls within the range of estimates from other low-and middle-income countries ($0.78-$9.90 per dose), though the financial cost per dose is relatively high in comparison. Countries such as Bangladesh and Mozambique delivered many more doses per day than Kampala, driving down the cost per dose. Kampala was able to hire some temporary health workers, whereas other countries, such as Côte d’Ivoire and Vietnam, did not report any new hires.
KEY TAKEAWAYS
- Single-antigen mass vaccination efforts can be cost-efficient in rapidly covering a large target population during a pandemic, though to improve the cost-efficiency of vaccine delivery in low-volume or non-emergency settings, KCCA can consider multi-antigen campaigns and integrating vaccine delivery with other health services.
- KCCA was successful in seconding staff and recruiting volunteers to enable the delivery of COVID-19 vaccination, but long-term investment is needed to address health care worker shortages in Kampala.
- The role of the private sector was critical in the delivery of COVID-19 vaccines in Kampala, and KCCA should continue to harness the power of the private sector to reach unvaccinated communities and strengthen primary health care.
This study is part of a multi-country project that utilizes standardized methods to generate cost evidence on the delivery of COVID-19 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.
