Project Overview

Strengthening and Improving Access to Immunization Programs

ThinkWell’s Sustainable Immunization Financing (SIF) project is committed to increasing access to immunization for all, which means ensuring that immunization programs are prioritized, financed sustainably, and responsive to new and emerging health challenges. Recognizing that vaccines are a crucial tool for protecting public health, we work to increase resources and partnerships that will contribute to stronger, more resilient immunization systems—and in turn, healthier communities—around the world. Since 2016, we have partnered with Merck Sharpe & Dohme, Corp. (a subsidiary of Merck & Co., Inc.) to study, document, and advocate for policies that prioritize SIF across nine countries and two regions (and counting).

Key Statistics on Immunization Funding

• Before the COVID-19 pandemic, only 11% of public spending on health was for prevention in low- and middle-income countries (LMICs), accounting for less than half of total spending on prevention. (1)
• Countries belonging to the Organization for Economic Co-operation and Development (OECD) spent only 3% of public health budgets on preventive services. (2)
• Immunization, as a critical preventive health service received a fraction of these allocations. And over the past five years, median spending on immunization was 0.3% of health budgets across countries in Europe. (3)

1. WHO. 2018. Public Spending on Health: A Closer Look at Global Trends. Accessed September 2021. Available at: www.who.int/publications/i/item/WHO-HIS-HGF-HFWorkingPaper-18.3.
2. Gmeinder, M. 2017. “The case for investing in public health.” OECD Health Division. Rome: HTAi 2017 Annual Meeting.
3. Pascaline Faivre, Goran Benčina, Rosanne Campbell, Sibilia Quilici, Nicolas Dauby, Goran Tešović, Paolo Bonanni, and Rosybel Drury. 2021. “Immunization funding across 28 European countries.” Expert Review of Vaccines, vol 20: issue 6. DOI: 10.1080/14760584.2021.1905257

Why is SIF Critical?

Despite their status as a core public health function, immunization programs struggle to secure sufficient resources from public budgets. This limits their ability to reach communities, adopt and quickly roll out new vaccines, and improve on how they are delivered.

In many ways, immunization programs are a victim of their own success. Policymakers may place a high value on immunization and public health, yet budgets remain flat, as prevention is far less visible than clinical and curative innovation. There is no global benchmark for how much countries should spend on immunization programs; however, variable coverage rates and relatively slow adoption of new vaccines and technologies suggest that immunization programs are not prioritized or financed as optimally as possible, which compromises the power of vaccines to save lives and protect population health.

Challenges to SIF are found across geographies and income levels. Immunization financing can be improved across all public systems despite the multitude of challenges that countries face, including:

1. Availability of funding
2. Willingness to fund
3. Utilization of available funds to optimize outcomes
4. Oversight and monitoring of financing to improve decision-making

Simply put, investing in immunization is investing in a stronger, healthier, and more equitable society. By investing in their people and economic progress, securing and sustaining sufficient financing for immunization, and leveraging the public and private sectors to increase the impact of immunization on population health and the economy, policymakers can establish a strong legacy for public health.

Establishing and maintaining SIF is a cross-sectoral endeavor, with both the public and private sectors having an important role to play. The public sector helps to define population health priorities, provide access, educate the public, and invest in strong regulatory and research institutions that promote innovation and scientific advancement. Simultaneously, the private sector brings vaccines to market and recognizes the economic benefits of public health for driving productivity. By working together, public and private sector actors can also support evidence generation and sharing, program delivery and performance, blended-financing efforts, and more. Understanding this need for cross-sectoral collaboration, ThinkWell convenes diverse stakeholders to advance this discussion.

ThinkWell supports countries of all income levels to improve prioritization and financing of high-impact health interventions, from helping to improve how purchasing decisions are made for primary health care, to bringing global and country-level attention to the need for sustainable immunization financing, and o improving the global evidence base on the costs of delivering immunizations.

How is ThinkWell Removing Barriers to SIF?

Our work provides relevant research and analysis, best practices and models, and strategies that support cross-sectoral collaboration to improve SIF by:

1. Knowing the challenges: Explore the challenges to SIF in a variety of contexts, including middle-income and high-income countries across Asia Pacific, Europe, and Latin America.

2. Finding solutions: Explore cross-country learnings, from traditional to innovative resource mobilization and utilization mechanisms.

3. Driving change for SIF: Access evidence-based resources that advance the dialogue on financing challenges and needs, as well as how stakeholders can be part of the solution.

Knowing the Challenges

ThinkWell’s approach to improving Sustainable Immunization Financing (SIF) is to identify the challenges and understand what is driving those challenges. Then, solutions are tailored to each country’s context. While each country context is unique, challenges fall within four buckets:

1. Availability of funding – For middle-income countries in particular, constraints in available public resources may require new strategies for resource mobilization.
2. Willingness to fund – For many countries, although public resources may exist, demonstrating value and unlocking funds for immunization can prove difficult.
3. Efficient fund utilization (or the lack thereof) – Inefficient fund delivery plagues health systems across income levels, which hinders equitable access to high coverage for immunization programs. This requires a greater understanding of which providers are paid to deliver immunization services, and how their payment incentivizes—or disincentivizes—outreach and uptake.
4. Robust oversight and monitoring of immunization financing – Immunization programs across the world are delivered through a partnership of multiple actors, from national and local governments to public and private insurance mechanisms. Understanding what is being spent by stakeholders involved in financing immunization programs and identifying where gaps may exist requires oversight and monitoring to improve efficiency, effectiveness, quality, and equitable access to immunization.

ThinkWell has worked with Merck Sharp & Dohme, Corp., (a subsidiary of Merck & Co., Inc.) to study immunization financing challenges around the world, and to offer global- and country-driven actions that policymakers, advocates, and communities can take to ensure stronger and more sustainably financed immunization programs that reach everyone.

To learn more about the SIF landscape and various challenges across countries and regions, explore our resources below.

Finding Solutions

To find relevant solutions to Sustainable Immunization Financing (SIF) challenges, ThinkWell has explored various policy options that countries across the globe have leveraged for both resource mobilization and driving efficiency among immunization programs. Our three resource guides—included below—detail solutions that can be leveraged to solve SIF challenges:

1. Innovative financing solutions
2. Strategic purchasing solutions
3. Potential public-private partnership models

Soto Moreno, Jose Alejandro, Yasmin Madan, and Martha Coe. (2019). “Improving Sustainable Immunization Financing in Colombia through Performance-Based Financing.” Washington, DC: ThinkWell.

Each guide details different solution mechanisms, identifies specific challenges that these mechanisms can solve, and illustrates examples with real-world case studies. These resource guides may provide inspiration to adapt an existing SIF model. However, the application of these solutions must be tailored to fit each country’s unique context. ThinkWell has developed bespoke strategies in multiple markets by diagnosing the challenges, exploring best practices, engaging cross-sectoral stakeholders to understand opportunities, and mapping feasibility.