Estimates from Tanzania and Indonesia on the cost of adjusting routine immunization outreach strategies due to COVID-19

20 July 2020

Preliminary data from the current COVID-19 pandemic indicate that immunization coverage rates are declining during the outbreak, likely due to the additional burden on the health system and to communities’ reluctance to visit health facilities. To prevent an increase in vaccine-preventable disease mortality and morbidity, countries need to rethink current immunization strategies to keep coverage high while minimizing the risk of COVID-19 transmission.

In an effort to help policymakers make critical decisions on how to safely provide routine outreach immunization during the COVID-19 outbreak, ThinkWell, with support from the Bill & Melinda Gates Foundation, estimated the additional cost per dose of conducting outreach services during the COVID-19 pandemic in Tanzania and Indonesia.

Using primary data from two recent country costing studies, ThinkWell estimated the additional cost per dose of several changes to immunization outreach delivery strategies: providing personal protective equipment (PPE) for health workers, instituting additional infection prevention and control (IPC) measures at outreach sites, deploying extra staff to ensure physical distancing and screen patients for COVID-19 symptoms, and changing the size and frequency of outreach session. All measures were costed for implementation at low, medium, and high intensity levels, and the cumulative costs of implementing several measures together was also estimated.

Our analysis for Tanzania and Indonesia showed that conducting outreach immunization during the COVID-19 pandemic could have the following cost implications:

  • Adding hand washing stations and hand sanitizer at outreach sites could increase the delivery cost per dose by 11-14%, while providing PPE (masks, gloves, and goggles) for health workers could bring an increase of 45-61%;
  • Deploying one additional crowd controller for physical distancing and screening during outreach sessions may increase costs up to 9%, while adding two extra staff and an infrared thermometer could increase the cost per dose by 42%;
  • Halving the frequency of outreach to reduce contacts between health workers and the community would likely lead to limited cost savings (-2 to -16%), while doubling the frequency to reduce the size of outreach sessions and facilitate physical distancing could increase the cost per dose by 18-40%;
  • Increasing the volume of doses delivered through outreach immunization to compensate for a drop in facility-based attendance of 50% could increase costs by just 11% per dose;
  • The combined effect of compensating for a 50% immunization drop at facilities, while also providing masks gloves and goggles to health workers, placing an advanced handwashing station and hand sanitizer at immunization sites, and deploying two additional workers with an infrared thermometer for physical distancing and screening could increase the cost per dose of 88-129%.

These illustrative findings demonstrate the potential impact that changes due to the COVID-19 response can have on the cost of delivering outreach immunization services in low- and middle-income countries, and can help policymakers define the optimal mix for their specific country context and needs.

Additional findings from this analysis can be found in the full report, available here. A complementary analysis on the cost of conducting immunization campaigns during COVID-19 was also published by ThinkWell while an analysis on the implication for routine immunization at health facilities by the Harvard T.H. Chan School of Public Health is forthcoming.