Costs of introducing pneumococcal, rotavirus and a second dose of measles vaccine into the Zambian immunisation programme: Are expansions sustainable?

Abstract

BackgroundIntroduction of new vaccines in low- and lower middle-income countries has accelerated since Gavi, the Vaccine Alliance was established in 2000. This study sought to (i) estimate the costs of introducing pneumococcal conjugate vaccine, rotavirus vaccine and a second dose of measles vaccine in Zambia; and (ii) assess affordability of the new vaccines in relation to Gavi’s co-financing and eligibility policies.MethodsData on ‘one-time’ costs of cold storage expansions, training and social mobilisation were collected from the government and development partners. A detailed economic cost study of routine immunisation based on a representative sample of 51 health facilities provided information on labour and vaccine transport costs. Gavi co-financing payments and immunisation programme costs were projected until 2022 when Zambia is expected to transition from Gavi support. The ability of Zambia to self-finance both new and traditional vaccines was assessed by comparing these with projected government health expenditures.Results‘One-time’ costs of introducing the three vaccines amounted to US$ 0.28 per capita. The new vaccines increased annual immunisation programme costs by 38%, resulting in economic cost per fully immunised child of US$ 102. Co-financing payments on average increased by 10% during 2008–2017, but must increase 49% annually between 2017 and 2022. In 2014, the government spent approximately 6% of its health expenditures on immunisation. Assuming no real budget increases, immunisation would account for around 10% in 2022. Vaccines represented 1% of government, non-personnel expenditures for health in 2014, and would be 6% in 2022, assuming no real budget increases.ConclusionWhile the introduction of new vaccines is justified by expected positive health impacts, long-term affordability will be challenging in light of the current economic climate in Zambia. The government needs to both allocate more resources to the health sector and seek efficiency gains within service provision.

Budget line items for immunization in 33 African countries

“…Most of the countries, including the 18 countries that did not report on donor funding, have unrealistically low immunization budget allocations per child in the birth cohort, such as US$1.54 in Burundi, US$1.99 in Sierra Leone and 2.96 in Liberia. Since vaccine costs of the ‘standard’ childhood vaccination schedule amounts to at least US$20 per child in the birth cohort, the budget allocations do not align with the amount of funding known to be spent on immunization ( Ahanhanzo et al , 2015 ; Griffiths et al , 2016 ; Geng et al , 2017 ). Explanations for the relatively low budget allocations include omission of donor funding, exclusion of ‘shared costs’, which may be reported elsewhere in the budget, and inaccurate budget predictions.…”

Introducing new vaccines in low- and middle-income countries: challenges and approaches

“…A range of factors may contribute to lower than desirable levels of vaccine introduction. Decision-making processes, economic and financial aspects of NVIs are critical ones and have been extensively described [10][11][12][13][14][15][16][17][18][19][20]. Besides these aspects, implementation and integration of new vaccines bring additional logistical complexity to delivery of existing immunization programs in LMICs.…”

Introduction of rotavirus vaccination in Palestine: An evaluation of the costs, impact, and cost-effectiveness of ROTARIX and ROTAVAC

“…When accounting for averted healthcare-related costs for households, using either vaccine is a costsaving intervention, highlighting the economic burden rotavirus represents for households and the health system in Palestine. Other studies conducted in the EMRO region have also found that rotavirus vaccine introduction is cost-effective or cost-saving compared to no vaccination [14,36,37]. When evaluating the switch, ROTAVAC presents an economic advantage over ROTARIX and shifting from ROTARIX to ROTAVAC was a cost-saving option from both the health system and societal perspectives.…”