A new study in The Lancet Regional Health – Western Pacific details Vietnam’s experience with a rapid reversal in its immunization financing policy. In 2023, as part of a broader governance decentralization effort and with decreasing international aid, the central government delegated the responsibility of financing the Expanded Program on Immunization (EPI) to provincial governments. The goal was to reduce the central government’s financial burden and improve efficiency through localized programs. However, this policy change had severe negative consequences, including widespread vaccine stockouts and the largest decline in childhood immunization coverage in over 20 years. The government quickly terminated the decentralization reform in July 2023, just a few months after it began.
The analysis highlights that the decentralization led to significant procurement issues and a lack of funding in less-developed provinces, exacerbating socioeconomic disparities. Wealthier cities like Hanoi and Ho Chi Minh City were better able to secure vaccines, while under-resourced provinces in mountainous and delta regions struggled with vaccine shortages and procurement delays. This resulted in a drastic decrease in the national full immunization rate for children under one year, which fell from over 87% in 2021 and 2022 to just 77% in 2023. The policy’s failure underscores key lessons for other middle-income countries: the central government should maintain the primary role in EPI financing and management, and capacity building and resource allocation for less-developed areas are crucial to ensure equitable and effective immunization programs.
Thumbnail image credit: Gavi
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