Costs of inaction to reach zero-dose and undervaccinated children in Europe and Central Asia

This report by UNICEF Europe and Central Asia Regional Office (UNICEF ECARO) and Triangulate Health examines the cost of inaction in reaching zero-dose and under-vaccinated children in Azerbaijan, Georgia, Moldova, and Ukraine. The analysis uses a modelling approach informed by desk review and key informant interviews to estimate the health and economic consequences of failing to achieve immunization coverage targets for key vaccines, including DTP, measles-containing vaccines (MCV), and Hib.

Key findings

• Failure to reach immunization targets leads to substantial economic burden, including healthcare costs, productivity losses, and outbreak response costs.
• In Georgia, every USD 1 invested in reaching zero-dose and under-vaccinated children yields USD 16 in economic returns.
• In Moldova, returns reach approximately USD 9 per USD 1 invested, while in Ukraine returns can exceed USD 70 per USD 1 invested, depending on vaccine and context.
• Productivity losses account for the largest share (~60%) of total economic burden, often exceeding direct healthcare costs.
• The analysis shows that returns on immunization remain high even in upper middle-income settings, despite increasing delivery costs.
• Current financing patterns are often skewed toward vaccine procurement, with underinvestment in delivery systems such as outreach, workforce, and demand generation.
• Persistent barriers include vaccine hesitancy, inequities in access, workforce constraints, and gaps in service delivery systems.

Thumbnail image credit: UNICEF/UN0759682/ Babajanyan