The Experts Weigh In: How to Get Governments to Prioritize Funding for Routine Immunization

22 September 2021

Written by Andrea Bare (Program Director, ThinkWell) and Martha Coe (Program Manager, ThinkWell)

Routine immunization is not clearly and consistently prioritized—nor is it sufficiently funded—in many countries across the income spectrum. Yet, the evidence has spoken: the benefits of immunization are undeniable. Not only is immunization successful in warding off disease—it is also a cost-effective health intervention. Economic and scientific studies continue to sing the praises of immunization’s value for preventing disease, however, this strong evidence base is not consistently reflected in health policies and budgets.

On September 15, 2021, ThinkWell convened the second event in its Counterpoint webinar series, where four experts were invited to discuss why routine immunization programs struggle to obtain sufficient and sustained funding, and how health advocates may respond to this challenge. Moderated by Margaret Cornelius, Deputy Director of the Private Sector Team at ThinkWell, the four panelists included Eduardo Banzon, Principal Health Specialist at the Asian Development Bank; Ulla Kou Griffiths, Senior Advisor on Immunization Financing at UNICEF and Honorary Associate Professor at the London School of Hygiene & Tropical Medicine; Catherine Goode, Founder of Goode Strategies; and Stefan Swartling, Professor of Global Transformations for Health at the Karolinska Institute. Each provided their unique perspective and expert recommendations on how to elevate financing for routine immunization, including:

1. Tell the full story of vaccination success to generate societal and political demand.
2. Create and maintain a shared agenda across the health advocacy spectrum.
3. Articulate the shared needs of the products, systems, and people involved in immunization.
4. Integrate immunization into primary health care.

1. Tell the full story of vaccination success to generate societal and political demand.

The irony is that when vaccination programs are successful, decision makers and the public can take these programs for granted. Instead, a negative press story, such as a gravely ill person in an intensive care unit, gets far more attention than the thousands of individuals who are safe and well because of vaccination. We must be careful not to become victims of our own success.

To champion routine immunization in the long term, advocates and immunization program managers need to provide ministers of health and finance a clear picture of what their countries would be facing without immunization programs. Providing preventive health care is often thankless, and for people to recognize the value of that investment, advocates must continually communicate the value of successful programs and the broad societal and economic benefits that they bring. There is an opportunity during the COVID-19 response to showcase how immunization programs are rising to the challenge of rolling out COVID-19 vaccines while also highlighting investment gaps, ensuring that both the public and policymakers appreciate the risks to population health if routine vaccinations do not continue—or if we do not prepare for future risks.

2. Create and maintain a shared agenda across the health advocacy spectrum.

 Advocates should start with, and come back to, what we have in common. Highlighting the reality that public health priorities compete for scarce resources, panelists emphasized the importance of stepping out of program and funding silos to find common ground. The different programs that make up primary health care, including immunizations, can align under a common agenda to increase broader primary health care funding, thus extending budget benefits across the entire system. Investments that have wider impact are more likely to gain the ears of those who hold the purse strings. As global policymakers come together to discuss funding for pandemic recovery and preparedness, advocates who call for a unified investment in comprehensive primary health care programs will make a stronger case for ongoing immunization funding.

3. Articulate the shared needs of the products, systems, and people involved in immunization.

Broad based investment in immunization involves three components to increase access and uptake: the vaccines, the vaccine delivery system, and vaccine education. Health advocates can better communicate why additional investment is essential by emphasizing the shared needs of the vaccines, systems, and people that sustain immunization programs.

• Vaccines: Sufficient investment is necessary to ensure that vaccine production capacity can meet both regular and peak demand when needed. Manufacturers make these investments when there is a clear signal of demand and financing for immunization programs from the market. The gap in ability to enable surge capacity to meet demand became abundantly apparent during the global COVID-19 pandemic, when countries experienced an urgent need for vaccine supply, along with the equipment and associated medicines required to treat COVID-19 patients. Although procurement models that can support more resilient manufacturing capacity come at a higher cost, investing sufficiently in immunization pays off. For instance, organizations such as UNICEF have shown that creating a healthy vaccine market can help bring in high-quality manufacturers that are prepared to meet vaccine needs.

• Systems: The global health care system and workforce have risen to the challenge of quickly and effectively administering available vaccines. Despite quick adjustments by health systems, the pandemic has revealed capacity challenges for delivering both routine and COVID-19 vaccines. The hurdles that vaccine delivery systems have experienced—such as limited points of access or outdated data systems—are often embedded in primary health care delivery and thus have negative effects that extend beyond immunization. Therefore, investments in vaccine delivery systems must be considered essential not only for effective immunization programs, but also for the overall well-being of a resilient primary health care system.

• People: Ultimately, people are at the heart of health. People drive vaccination demand, and without this demand, prioritization of immunization will be limited. Investments must be made to consistently nurture the value of routine immunization through frequent education and communication, thereby building confidence and cultivating societal demand for impactful vaccination programs.

4. Integrate immunization into primary health care.

Immunization financing must be considered within the broader context. Panelists agreed that primary health care budgets are generally insufficient, meaning that immunization budgets are likewise left scant. The panel discussed the need to better highlight what primary health care is composed of to ensure that immunization is considered central to strong primary health care systems—including vaccinations for children, adolescents, and adults. Additionally, panelists noted that by evaluating other well-funded areas across the primary health care system, advocates can identify opportunities for cost savings and efficiencies. The traditional operating model, particularly for countries that have leveraged donor funding for immunization or other primary health care services, such as HIV or tuberculosis, is to have siloed program funding. However, vaccination services benefit from the investment of other budget lines, including health infrastructure and clinic staff. Maintaining these siloes may harm access to prevention services or primary health care in the long run. Instead, promoting an integrated health delivery approach—which includes vaccination alongside routine primary health care—could provide new opportunities to bolster immunization programs that are prepared to treat a variety of diseases.

If you want to learn more about ThinkWell’s work in sustainable immunization financing, you can read about it here. You may also watch the full webinar recording below.

This blog was produced by ThinkWell in partnership with and funding from Merck Sharp & Dohme Corp. (MSD), a subsidiary of Merck & Co., Inc., Kenilworth, New Jersey, USA. The views and opinions expressed by the panelists are their own and do not necessarily reflect the views and opinions of ThinkWell or MSD.