Abstract
Despite their frequent use in Nigeria, little evidence exists on the cost of campaigns, and none thus far on the cost of integrated campaigns. This study aimed to estimate the full economic and financial costs of delivering yellow fever (YF) vaccines, as well as co-delivery of YF and Meningococcal A (MenA) vaccines, through campaigns in Nigeria. The evidence from this study can be used by the Nigerian government and its partners to inform planning and budgeting for future campaign phases, as well as inform other countries and donors.
As part of Nigeria’s 10-year yellow fever (YF) elimination plan, immunization campaigns have been implemented in a phased manner across the country. This study includes three states which implemented campaigns from 2019-2020. In one of these (Anambra), the YF campaign, targeting those aged 9 months – 44 years, was integrated with MenA delivery targeting 1- to 6-year-olds. The campaigns were coordinated by the Nigerian government and primarily funded by Gavi, the Vaccine Alliance. Post-campaign coverage surveys reveal coverage levels of 83% in Katsina, 82% in Rivers, and 76% (YF) and 96% (MenA) in Anambra.
Using an ingredients-costing approach, cost data from a payer perspective were collected from two states which only delivered YF vaccines (Katsina and Rivers) and the state where both YF and MenA vaccines were delivered (Anambra). The sample included 78 randomly selected health facilities involved in the campaigns. Data were collected retrospectively between October 2020 and May 2021 from all levels of government as well as development partners. Findings are presented in 2020 USD weighted by the probability of sampling and volume delivered. Variance is shown through the use of 95% confidence intervals.
The average financial cost per dose of YF vaccine delivered was $0.34 in Katsina and $0.29 in Rivers compared to $0.35 for YF and MenA in Anambra, while the economic delivery unit costs were $0.62, $0.85 and $0.71 respectively. The financial cost of the campaign was driven by per diem and allowances, vaccine injection supplies, and transport and fuel costs, while paid and volunteer labor were the key economic cost drivers. Large subnational variation in unit costs were observed especially in regards to economic costs.
The average financial cost per dose across states was somewhat similar in spite of integration of MenA vaccine in Anambra , indicating possible efficiency in the integration of health programs. Due to the many other differences in characteristics and health system capacity across states, and in the ways that campaigns were implemented, it was not possible to assess the precise impact of integration on the delivery costs. However, our findings did not show efficiencies from co-delivery. This may have been because the economies of scale that would be expected from delivering two antigens were not observed. Despite delivering both antigens during the campaign, wards in Anambra delivered fewer vaccines on average than the wards in Katsina and Rivers. This suggests that vaccine volume delivered by the wards seemed to be a more important driver of the delivery unit cost than co-delivery.