Project Overview

ThinkWell seeks to improve sustainable immunization financing in countries across the globe. Whether public immunization programs 1) do not have the funding required to sustain and expand their immunization schedules to respond to public health needs or 2) do not have financing structures that optimize immunization outcomes, every country can work to improve immunization financing. This project is supported by Merck & Co., Inc.



This project aims to 1) improve understanding of immunization financing structures, flows, and surrounding political economy, 2) provide global learning on financing solutions, and 3) identify ways that private sector/industry stakeholders can work with countries as thought partners to strengthen financing for sustainable immunization programs.

System Approach to Immunization Financing

ThinkWell applies a systems approach to immunization financing. To fully understand the challenges with immunization financing and what opportunities a public system may present, it is necessary to look at how immunization fits within the larger health system and how the health system is prioritized and structured. We define sustainable immunization financing as increased national budgets and strong systems to efficiently absorb increased budgets for sustained and growing immunization programs.

thinkwell merck

Improved Understanding

To better understand the factors affecting immunization financing in the region, ThinkWell performed a cross-country analysis of six representative countries in the Asia Pacific region. In that analysis, we identified key factors that influence immunization program financing and pressure tested the findings in additional markets in Latin America. The landscaping yielded four major trends that affect financing for immunization:

  1. Diversified domestic revenue for health: Countries are increasingly reliant on domestic revenue to finance their health budgets
  2. From input financing to strategic purchasing: Countries are moving away from input financing towards strategic purchasing
  3. Decentralization: Financial decision making occurs at different government levels within countries
  4. Levels of prioritization: Entry points for improved financing can range from the health system level, prevention programming, or the immunization program

This analytical framework has been leveraged to understand the broader European region and to profile immunization financing in nine countries:

Sustainability Solutions

Innovative financing for immunization

Though there is much interest among immunization financing stakeholders in innovative financing mechanisms, there is little knowledge regarding how different mechanisms function and how they could be applied to positively influence financing for sustained and growing national immunization programs. ThinkWell developed an Innovative Financing for Immunization resource guide that helps to answer these questions. Immunization programs across the globe can use the guide to further efforts towards improved financing.

Leveraging expanding public insurance system for immunization

Public insurers play major health financing roles in countries across the globe. Many countries, particularly those outside of Europe, have not yet explored how to fully leverage public insurers to improve sustainable immunization financing. Through purchasing health and immunization services in a strategic manner, public insurers can both bring in additional resources for immunization programs and help improve efficiency and performance of immunization programs. The Strategic Purchasers and Immunization: How to Leverage these Major Players for Public Program Improvements resource guide provides specific ways for an insurer to strategically engage with public immunization programs. This guide helps the reader to better understand how their purchaser functions within their country and health system context. It also highlights exemplary models that have used public insurance mechanisms to sustain and grow immunization programs.

Public-private partnerships for immunization programming

For public immunization programs that face resource mobilization and performance challenges, leveraging a partnership between private and public actors can unlock the strengths of both sides to create positive outcomes. This resource guide provides a useful framework for how to bring together public and private motivations in designing solutions to address challenges. The Public-Private Partnerships: Why, What, and How for Sustainable Immunization Financing resource guide provides an overview of the different categories and models of public-private partnerships and illustrates these with cases from health and non-health sectors across the globe. For private sector actors interested in pursuing tangible solutions for government partners, this resource guide helps define what good could look like, guide the reader through selecting a particular model, and then support the adaptation of that model to their particular needs.

Thought Partnership

The Sustainable Immunization Financing project goes beyond learning and engages on improving financing for public immunization programs. We build engagements upon a foundation of understanding regarding country context and immunization financing challenges and seek to address an ongoing challenge within the program. Thought partnership with public programs requires broad stakeholder engagement, technical inputs, and tailored solutions. ThinkWell is currently collaborating with stakeholders in Colombia to facilitate this process: we are providing technical inputs to a performance-based financing regulation based on global learnings and are identifying channels through which the public immunization schedule can be expanded with a detailed review of financing options. The project also aims to start regional and global conversations regarding sustainable immunization financing. We facilitate dialogue through policy briefs (available for Asia Pacific, Latin America, European, and global contexts).

Activating Dialogue

In the wake of the pandemic, as countries struggle to roll-out COVID-19 vaccines and to recover and maintain routine vaccination rates, sustainable investment to strengthen immunization systems is more important than ever. This year, ThinkWell and MSD are launching a series of activities to call attention to this need and activate conversation on sustainable immunization financing for the programs of today and tomorrow.

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