A new peer-reviewed article published on PLOS One examines the cost and cost drivers of delivering COVID-19 vaccines in low- and middle-income countries, drawing on retrospective, bottom-up costing studies conducted in Bangladesh, Côte d’Ivoire, the Democratic Republic of the Congo, Mozambique, the Philippines, Uganda, and Vietnam. The study, led by Helath Systems Insight (formerly ThinkWell Institute), estimates both financial and economic delivery costs from a payer perspective using detailed cost data collected from 290 sites across multiple health system levels, complemented by qualitative interviews with key informants.
Key findings
Financial delivery costs (excluding vaccine procurement) were relatively low—ranging from USD 0.29 to USD 2.18 per dose—largely reflecting severe resource constraints and delayed funding at implementation level rather than low resource needs.
Economic delivery costs ranged widely (USD 1.14–9.50 per dose) and were primarily driven by paid and unpaid labor, underscoring the central role of health workers and volunteers during the emergency response.
Delivery costs per dose fell sharply as vaccination programs scaled up, with higher daily volumes strongly associated with lower unit costs across countries, delivery modalities, and sites.
Campaign-style delivery generally achieved lower unit costs than continuous delivery when associated with higher throughput, highlighting economies of scale.
Early rollout phases targeting small priority populations were substantially more expensive per dose than later phases delivering at scale.
High coverage was achieved through extraordinary political prioritization, health worker commitment, and volunteer mobilization, despite widespread shortages in funding, staffing, transport, and cold-chain capacity.
These findings highlight that low observed delivery costs during COVID-19 were achieved under unsustainable conditions, reinforcing the need for timely investments in health workforce capacity, routine delivery infrastructure, and flexible financing mechanisms to enable efficient, resilient vaccine delivery without overburdening health systems.
How can the findings be used?
These findings provide critical, real-world evidence for planning future pandemic responses, adult vaccination programs, and new vaccine introductions.
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