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Vaccine. 2016 Jun 28. pii: S0264-410X(16)30474-1. doi: 10.1016/j.vaccine.2016.06.050. [Epub ahead of print]
Griffiths UK1 Bozzani FM2 Chansa C3 Kinghorn A4 Kalesha-Masumbu P5 Rudd C6 Chilengi R6Brenzel L7 Schutte C8.
Introduction 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 Gavis co-financing and eligibility policies.
Data 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.
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.
While 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.