A new study published in Cost Effectiveness and Resource Allocation provides the first empirical evidence of COVID-19 vaccine delivery costs in Malawi, revealing financial and economic burdens. Researchers collected primary data from 20 health facilities across four districts (April 2021–March 2022), finding a financial cost of $4.55 per dose delivered—with sensitivity analyses indicating a range of $3.23–$6.33. This exceeds modelled COVAX estimates ($2.34–$4.36), reflecting Malawi’s real-world challenges. Transportation (32.3%), per diem/travel allowances (24.1%), and labor (13.6%) drove over 70% of financial costs. Critically, the study uncovered massive hidden expenses: when accounting for reallocated staff time, volunteer opportunity costs, and donated vehicles, the economic cost surged to $16.15 per dose, with labor reallocation alone constituting 66.6% of this burden.
The research highlights systemic pressures on Malawi’s health system, where scarce resources forced extensive staff diversion from routine services toward COVID-19 vaccination—jeopardizing other health priorities. Outreach strategies (door-to-door/mobile sites) amplified transport expenses due to vaccine hesitancy and difficult geography. Despite COVAX’s assumption of “surge staffing,” Malawi hired few new workers, relying instead on overstretched existing personnel. With only 7.7% coverage achieved during the study period (far below the global target of 70%), the findings underscore how low uptake inflates per-dose costs and exacerbates resource strain. The authors urge policymakers to prioritize realistic budgeting, surge workforce planning, and integrated service delivery to mitigate trade-offs in future pandemics.
Thumbnail image credit: Management Sciences for Health
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