Thinkwell Covid vaccine immunization

Now’s the Time to Invest in Sustainable Immunization Financing

10 February 2021

What’s one of the greatest public health investments but is often underfunded? Immunization.

“[Immunization] programs are a victim of their own success. The expanded program for immunization started in the 1970s around the world…and today, in most parts of the world, a lot of diseases [such as diphtheria, pertussis, tetanus, poliomyelitis, measles, and tuberculosis] aren’t a major part of our lives anymore…so [immunization] is not front of mind,” ThinkWell Program Manager Martha Coe said at the “Prevention and Vaccines in the Covid-19 Era: Bold Choices for Financing Immunization Systems” webinar hosted by MSD Brussel’s Policy Centre on January 27, 2021.

The Covid-19 pandemic has underscored how critical vaccines and prevention services are for resilient health systems. But beyond the massive undertaking of developing new vaccines and distributing them, financing systems to efficiently deliver these products is no easy task. And when a health crisis hits and vaccines are critically needed, health budgets are often under strain and their systems are unprepared to absorb new funding or vaccines effectively.

Even though preventative services can reduce healthcare costs over time, they’re often deprioritized as an investment area due to the lag in tangible benefits. In a study of Europe prior to the pandemic, less than 3% of the total health care spending was allocated to prevention and less than 0.5% was allocated to vaccination on average across countries.

Since 2016, ThinkWell has consulted for Merck/MSD on sustainable immunization financing. We’ve looked at health systems across Latin America, Asia, and Europe to understand how immunization is financed, what challenges countries face, and how external stakeholders can engage with challenges and support governments to strengthen immunization programs.

In 2019, we started studying what drives decisions around how funds for immunization are mobilized and used in the European Union (including the UK). Of course, each EU member state has its own economic, political, and social contexts as well as unique immunization systems and funding scenarios. Still, we identified four key themes that drive immunization financing across the region.

  1. Political prioritization drives funding: All countries prioritize their health sectors, but funding for preventative services including immunization is not always a political priority. This has led to coverage gaps, among other challenges.
  2. Financing is focused on performance improvement: Instead of investing in ways to build their immunization budgets, most countries focus on using available funds to improve vaccination coverage rates.
  3. Public systems engage new actors in immunization financing: As immunization programs grow, governments often appoint more actors to finance and deliver services. This creates complex systems that are not always accountable, cohesive, or well-coordinated.
  4. Limited guidance provided from the regional level: Even though EU member states experience common challenges with immunization financing, the EU’s governing body doesn’t provide much overarching guidance or learning platforms for countries to share their experiences.

With the momentum behind immunization ballooning as coronavirus vaccines are rolled-out, we hope that Europe will invest in prevention for the long-term. Governments can start by understanding and leveraging key immunization financing drivers. We have an opportunity to get bolder when it comes to confronting these drivers in policy design and innovating new approaches to financing immunization systems.

As a first step, “we would love to see the EU establish a platform where immunization and prevention can be discussed beyond Covid,” Martha Coe said.

And what can external stakeholders do to seize and maintain the momentum around prioritizing immunization? In addition to immunization advocacy, “we can provide more resources and capacity to increase knowledge and support [governments with limited capacity to find] solutions that move the needs towards sustainable immunization financing,” Coe concluded.

When governments embrace smart investments in immunization, we’ll begin to fully realize the potential of immunization programs both during and beyond the Covid-19 crisis.

If you want to learn more about our research on sustainable immunization financing in Europe, you can read this brief and view this presentation. In addition, you can explore our other work for Merck/MSD here.

You can watch the full webinar recording here:

Written by Leah Breen with Martha Coe