What will it cost to deliver new maternal vaccines in Bangladesh and Nepal?

As maternal RSV vaccines move closer to introduction in low- and middle-income countries, policymakers are asking how much will it cost to deliver them through their health systems? A new BMC Public Health article by Baral and colleagues [in press] projects the five-year cost of introducing and delivering maternal immunization in Bangladesh and Nepal, two South Asian countries which are potential early adopters of maternal RSV and other future maternal vaccines. Using an activity-based, prospective costing approach, researchers worked with national stakeholders in both countries to define realistic delivery strategies, largely anchored in existing maternal tetanus toxoid vaccine delivery platforms. They combined stakeholder interviews with primary cost data from subnational vaccine stores and health facilities, and estimated both financial and economic costs to the health system in 2023 US dollars.

The study finds that non-vaccine delivery costs per maternal dose are relatively modest but vary substantially by context. In Bangladesh, the financial cost per dose (excluding vaccine price) is estimated at US$0.45, compared with US$1.81 in Nepal; corresponding economic costs are US$2.01 and US$4.49 per dose, respectively. Health worker training and demand generation emerge as major cost drivers in both settings. Lower unit costs in Bangladesh reflect a larger target population and economies of scale, while anticipated coverage levels and baseline health system capacity gaps help explain higher costs in Nepal. 

Thumbnail image credit: Shutterstock / AP Tolang