Milestones :: Perspectives [to 5 November 2016]

Vaccine
In Press, Corrected Proof, Available online 28 October 2016
Funding gap for immunization across 94 low- and middle-income countries
Original Research Article
Sachiko Ozawa, Simrun Grewal, Allison Portnoy, Anushua Sinha, Richard Arilotta, Meghan L. Stack, Logan Brenzel
Highlights
:: Estimated financing and funding gap for vaccine, supply chain and service delivery.
:: Identified immunization funding gap: $7.6 billion over 2016–20 across 94 countries.
:: On average, the funding gap represents 2.3% of government health expenditures.
:: Largest funds needed for service delivery and supply chain to meet projected costs.

Abstract
Novel vaccine development and production has given rise to a growing number of vaccines that can prevent disease and save lives. In order to realize these health benefits, it is essential to ensure adequate immunization financing to enable equitable access to vaccines for people in all communities. This analysis estimates the full immunization program costs, projected available financing, and resulting funding gap for 94 low- and middle-income countries over five years (2016–2020). Vaccine program financing by country governments, Gavi, and other development partners was forecasted for vaccine, supply chain, and service delivery, based on an analysis of comprehensive multi-year plans together with a series of scenario and sensitivity analyses.

Findings indicate that delivery of full vaccination programs across 94 countries would result in a total funding gap of $7.6 billion (95% uncertainty range: $4.6–$11.8 billion) over 2016–2020, with the bulk (98%) of the resources required for routine immunization programs. More than half (65%) of the resources to meet this funding gap are required for service delivery at $5.0 billion ($2.7–$8.4 billion) with an additional $1.1 billion ($0.9–$2.7 billion) needed for vaccines and $1.5 billion ($1.1–$2.0 billion) for supply chain. When viewed as a percentage of total projected costs, the funding gap represents 66% of projected supply chain costs, 30% of service delivery costs, and 9% of vaccine costs. On average, this funding gap corresponds to 0.2% of general government expenditures and 2.3% of government health expenditures.

These results suggest greater need for country and donor resource mobilization and funding allocation for immunizations. Both service delivery and supply chain are important areas for further resource mobilization. Further research on the impact of advances in service delivery technology and reductions in vaccine prices beyond this decade would be important for efficient investment decisions for immunization.

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Bulletin of the World Health Organization
Volume 94, Number 11, November 2016, 785-860
http://www.who.int/bulletin/volumes/94/11/en/

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RESEARCH
Inequalities in full immunization coverage: trends in low- and middle-income countries
María Clara Restrepo-Méndez, Aluísio JD Barros, Kerry LM Wong, Hope L Johnson, George Pariyo, Giovanny VA França, Fernando C Wehrmeister & Cesar G Victora
http://dx.doi.org/10.2471/BLT.15.162172
Abstract
Objective
To investigate disparities in full immunization coverage across and within 86 low- and middle-income countries.
Methods
In May 2015, using data from the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys, we investigated inequalities in full immunization coverage – i.e. one dose of bacille Calmette-Guérin vaccine, one dose of measles vaccine, three doses of vaccine against diphtheria, pertussis and tetanus and three doses of polio vaccine – in 86 low- or middle-income countries. We then investigated temporal trends in the level and inequality of such coverage in eight of the countries.
Findings
In each of the World Health Organization’s regions, it appeared that about 56–69% of eligible children in the low- and middle-income countries had received full immunization. However, within each region, the mean recorded level of such coverage varied greatly. In the African Region, for example, it varied from 11.4% in Chad to 90.3% in Rwanda. We detected pro-rich inequality in such coverage in 45 of the 83 countries for which the relevant data were available and pro-urban inequality in 35 of the 86 study countries. Among the countries in which we investigated coverage trends, Madagascar and Mozambique appeared to have made the greatest progress in improving levels of full immunization coverage over the last two decades, particularly among the poorest quintiles of their populations.
Conclusion
Most low- and middle-income countries are affected by pro-rich and pro-urban inequalities in full immunization coverage that are not apparent when only national mean values of such coverage are reported.