ThinkWell conducted costing studies of three immunization campaigns, including two which involved the co-delivery of antigens, in order to generate evidence on the cost of delivery vaccines through campaigns, and inform the development of methodological guidance for campaign costing. The campaigns costed were the measles-rubella (MR) catch-up campaign in four states in India held from 2017-2019, the integrated MR catch-up campaign held in Sierra Leone in 2019, and yellow fever campaigns in three states in Nigeria during 2019-2020, including one state where meningitis A (MenA) vaccines were delivered alongside yellow fever. ThinkWell also released a policy brief on the cost of integrated campaigns.
This study estimated the cost of delivering the measles-rubella (MR) catch-up campaign in four states in India (Assam, Gujarat, Himachal Pradesh and Uttar Pradesh). From 2017 to 2020, the India undertook a large-scale vaccination campaign during which more than 324 million children aged between 9 months and 15 years were vaccinated with a dose of MR vaccine. The financial delivery cost per dose ranged from US$0.16 to US$0.34, including costs incurred by the government, WHO and UNICEF. The economic cost per dose incurred by the government in Uttar Pradesh state was estimated at US$0.87. The estimated financial delivery cost per dose was higher than the government pre-fixed budget per child for the campaign, though the study also found underutilization of the MR budget in two states, and use of other sources of funding for the campaign. This indicates a potential need for more flexibility around the use of campaign budgets in Indian states.
This study estimated the full financial and economic cost of the integrated MR catch-up campaign held in Sierra Leone in June 2019. Nationwide, MR was co-delivered with oral polio vaccines (OPV), while vitamin A supplements and albendazole de-worming tablets were also delivered in half of the country. The financial cost of US$0.39 per vaccine dose delivered and an economic cost of US$0.84 per vaccine dose delivered were estimated. The study found financial cost efficiencies in areas that co-delivered both vaccines and nutrition interventions compared to areas that only delivered vaccines, though the opportunity costs of labor in areas which co-delivered the nutritional interventions were greater, indicating an increased burden on the health system. This study is the first to analyze the cost of an integrated campaign and the cost evidence generated can be used for future planning and budgeting of campaigns in Sierra Leone and similar settings.
This study estimated the full financial and economic cost of yellow fever campaigns in three states in Nigeria (Anambra, Katsina and Rivers), including one state where meningitis A (MenA) vaccines were delivered alongside yellow fever (Anambra). The campaigns were held between September 2019 and October 2020 and data was collected from federal, state, local government authority and facility levels from October 2020 until May 2021. This study aimed to identify the cost profiles and cost drivers of the campaigns in the three states as well as the cost of integrating MenA delivery with yellow fever immunization.
This policy brief presents new costing evidence on the operational cost of immunization campaigns, including two integrated campaigns. Over the coming years, campaigns which co-deliver multiple vaccines and interventions are likely to be used more often, with the need for efficiencies elevated by the COVID-19 pandemic. Therefore, it is crucial that delivery costs are accurately estimated to inform planning, budgeting, and ensure adequate funding.
