The Value, Urgency, and Sustainability of Immunization

25 May 2021

Written by Martha Coe (Program Manager, ThinkWell) and Anupama Tantri (Executive Director, Global Vaccine Public Policy Development; Merck Sharp & Dohme Corp.) 

Fifteen months into the global COVID-19 pandemic, the tie between public health and the economic value of disease prevention and immunization has never been more apparent. The world is looking to vaccination to help prevent illness, hospitalization, and death from COVID-19 as well as reopen economies.

The Asia-Pacific Economic Cooperation (APEC) Life Sciences Innovation Forum recently hosted a webinar to explore how countries can unlock and leverage funds for COVID-19 vaccination and across the life-course moving forward. ThinkWell and Merck Sharp & Dohme Corp. (MSD) were pleased to take part in the webinar and build on our ongoing work on sustainable immunization financing. Moderated by Anupama Tantri from MSD, the three expert panelists, Dr. Chunhuei Chi from Oregon State University, Dr. Mursaleena Islam from ThinkWell, and Dr. Ping-Ing Lee from National Taiwan University, provided insights and recommendations on how best to secure and leverage financing for COVID-19 and for immunizations across the life-course, including:

1. Invest in public health systems and infrastructure to achieve equitable access,
2. Use robust and actionable economic evidence to mobilize and allocate resources efficiently, and
3. Improve awareness of the value of vaccination among decision-makers to mobilize resources and justify investments.

1. Invest in public health systems and infrastructure to achieve equitable access

Availability is not the same as accessibility. At the outset, Dr. Chi noted that even if countries have procured COVID-19 vaccine doses and have them available in country, they may not be reaching all their populations in need. For example, barriers in delivery systems can postpone availability for certain geographies or hourly wage workers may need vaccination sites to be open at different hours than their work shifts in order to get vaccinated.

To ensure rapid and equitable access to COVID-19 vaccines, countries need to invest in the following three areas:

• Infrastructure to reach new populations or those in underserved or hard-to-reach areas. This includes expanding sites where vaccines are administered and ensuring that the cold chain and supply chain can support these new sites.
• Human resources to staff new or expanded vaccination sites and enhance outreach efforts to increase uptake.
• Information systems to track vaccination status and help assess the impact of vaccination in protecting vaccinated individuals from COVID-19, as well as in preventing transmission.

These investments can have long-serving impact beyond the pandemic to strengthen equitable access to other vaccinations across the life-course. For some countries, the pandemic has made apparent the fragility of and gaps in their public health infrastructure. Investments to respond to the pandemic provide an opportunity to have broader impact on immunization programs and public health.

2. Use robust and actionable economic evidence to mobilize and allocate resources efficiently

Securing sufficient and sustained resources for routine immunization requires costing and budget information that is specific to the country context and use-case. Dr. Islam shared three real-world case studies, conducted by ThinkWell with country and multilateral partners, that demonstrate the criticality of contextually relevant economic evidence to secure the resources needed for both routine vaccination and COVID-19 priorities.

• The first case study looked at the use of costing data to secure the resources necessary to deliver routine vaccination services safely during the COVID-19 pandemic. COVID-19 precautions (e.g., personal protective equipment and other infection control measures) were found to increase the cost of delivering routine immunization services by 20% to 129%, depending upon country and delivery specifics. Based on this data, government and other decision-makers could better plan and allocate resources for delivery.
• The second case study demonstrated the importance of accurate costing data to support COVID-19 vaccine roll out. The COVAX Working Group developed robust cost estimations for COVAX member countries and donors on the incremental delivery costs for COVID vaccines across all 92 Advance Market Commitment (AMC) countries. Robust costing and modeling found that it will cost US$1.66 to deliver each dose. This information helped the World Bank support resource allocation and prioritization.
• The third case study zoomed in on Indonesia and the use of budget data to protect routine immunization programs during the COVID-19 pandemic. ThinkWell researchers worked with the Indonesia Ministry of Health and local-level managers to improve visibility of COVID-necessitated budget reallocations on routine immunization services. This work found that routine immunization budgets declined across all of the assessed districts, but the magnitude of decline varied. The results informed detailed recommendations for decision-makers in Indonesia’s Ministry of Health to be able to respond to COVID-19, as well as maintain routine immunization programs. This case study also underscored the importance of understanding sub-national level costing information to ensure that vaccines reach the last mile and programs achieve equitable access to COVID-19 and routine vaccinations.

3. Improve awareness of the value of vaccination among decision-makers to mobilize resources and justify investments

The full health, economic, and societal benefits of immunizations should be captured and reflected in value assessments and funding decisions. As Dr. Lee noted, many middle-income countries have gaps in the vaccines available through their public immunization programs. Immunization programs must compete for resources alongside many other health interventions, and greater awareness and evidence on the value of vaccination can help to improve the prioritization of and allocation of resources to fill these gaps. Dr. Lee noted that traditional cost-effectiveness analysis may not take into account the broader, more comprehensive benefits of vaccination. Greater awareness among policymakers, health care providers, and the public of the broad returns on investment is necessary to support resource mobilization for, as well as access to and uptake of vaccination services. A variety of channels can be used to reach these audiences including public education, the media, and medical education.

If you want to learn more about ThinkWell’s work in sustainable immunization financing, you can read about it here.

You can watch the full webinar recording below. You can view the accompanying slides here.

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.