Expert Insight

How countries can maintain health gains from immunization

As someone who has worked to strengthen health systems for more than 20 years, I’ve heard (and even made) a lot of arguments about whether one intervention versus another is more important or a better value for money. Many different types of interventions can save lives — but the fact is immunization programs are one of the best investments a government can make.

In 2017, more babies and children around the world receive lifesaving vaccines than ever in history. But hard-won progress could be lost if countries don’t find a way to sustain financing for immunization over the long term. This will be particularly challenging for developing countries, which receive external support and may see funding decrease in the future.

Immunization programs prevent unnecessary deaths and the scourge of crippling diseases. And they are cost-effective — lowering health costs and boosting economic growth. A recent analysis published in Health Affairs found that every dollar low- and middle-income countries invest to expand access to vaccines returns $16, and the return increases to $44 once broader economic benefits are taken into account.

But immunization programs demand steady, robust investments. Except in rare cases where a disease can be completely eradicated, immunization must be continued indefinitely. If immunization were stopped, diseases could come roaring back — just as falling rates of measles immunization have led to outbreaks in many countries.

They also require long-term investments as populations grow and as more vaccines are introduced and adopted.

Although coverage in the poorest countries has improved significantly, 1 in 5 children in Africa still do not receive the most basic vaccines. And just 5 percent of the world’s children receive all 11 vaccines recommended by the World Health Organization.

As the mother of two children who were vaccinated for measles, mumps and rubella, Hepatitis A and Varicella, among others, as part of routine immunization, it’s heartbreaking for me to think about children who will die from vaccine-preventable diseases.

Fortunately, the lowest-income countries do get help. Gavi, the Vaccine Alliance, was founded in 2000 to help the world’s poorest countries introduce new, lifesaving vaccines and strengthen immunization programs. But Gavi doesn’t support countries indefinitely. In order to concentrate its resources on the poorest countries, only countries with per capita income below a certain threshold (currently $1,580) are eligible. And, as many of these countries have experienced much-needed and welcome economic growth, some now face the process of transitioning from Gavi support.

These transitioning countries must rapidly scale up immunization financing, or risk losing ground — and lives — to deadly yet preventable diseases.

Strong immunization programs require sustained and predictable funding for vaccine procurement and supply chains as well as primary care facilities and staff that deliver immunization as part of a broader program of health services. As countries transition away from development assistance, their governments must plan to ensure adequate and sustainable financing for these efforts. This is not easy.

Decision-makers and advocates have questions like: Does the national budget have an adequate line item for vaccines and injection supplies? What initiatives are needed to ensure that the full complement of vaccines gets to all babies and children who need them? And, are we getting good prices for the procurement of vaccines?

The good news is a new open-access tool is serving up practical advice for policymakers, program managers and advocates to help them make sure that immunization programs continue uninterrupted as their countries transition from donor assistance. The tool can help them to evaluate the pros and cons of potential funding sources and make a viable plan for how to pay for immunization programs. It also offers ideas for building broad political support for these programs, which is crucial for sustained domestic funding. In addition, it highlights ways to improve vaccine procurement practices to keep costs under control.

Two important themes stand out:

Countries need to focus on making their limited health budgets work harder. Pursuing an innovative financing mechanism doesn’t always pay off, and may be more of a distraction. Mechanisms such as earmarks or trust funds are likely to play only a supporting role financing an entire immunization program. They don’t guarantee additive funding, and can add complexity. Even with constrained resources, a country’s general revenue still offers the best option as it’s often more predictable, equitable, efficient and sustainable than other revenue sources. Well-timed and coordinated budget advocacy can play an important role in improving the level, prioritization and stability of general revenue flows to health, including immunization.

Immunization financing needs to be considered within the context of universal health coverage (UHC); these two things need to go hand-in-hand. As one of the most cost-effective lifesaving health interventions, immunization figures prominently in UHC. Vaccines are a vital public health tool for which governments should be responsible. In practical terms, this means immunization should be included in a country’s essential health services package or the national health insurance system’s benefits package. As more countries move toward UHC — and as health financing and service delivery arrangements become more complex — countries must decide how to incorporate institutional responsibilities for specific immunization program functions and ensure that financial incentives don’t disadvantage immunization services.

Mobilizing greater domestic resources to support vital programs — like immunization — will become increasingly important when traditional donor funding plateaus or declines — and as more countries move from low- to middle-income status. In preparing for these transitions, and recognizing that middle-income countries are home to the majority of the world’s poorest populations, the global development community must help strengthen local capacity and systems with practical how-to advice and support.


This article was originally published on February 28, 2017 by the Huffington Post.