Background

Childhood immunisation is one of the most cost-effective health interventions. However, despite its known value, global access to vaccines remains far from complete. Although supply-side constraints lead to inadequate vaccine coverage in many health systems, there is no comprehensive analysis of the funding for immunisation. We aimed to fill this gap by generating estimates of funding for immunisation disaggregated by the source of funding and the type of activities in order to highlight the funding landscape for immunisation and inform policy making.

Methods

For this financial modelling study, we estimated annual spending on immunisations for 135 low-income and middle-income countries (as determined by the World Bank) from 2000 to 2017, with a focus on government, donor, and out-of-pocket spending, and disaggregated spending for vaccines and delivery costs, and routine schedules and supplementary campaigns. To generate these estimates, we extracted data from National Health Accounts, the WHO–UNICEF Joint Reporting Forms, comprehensive multi-year plans, databases from Gavi, the Vaccine Alliance, and the Institute for Health Metrics and Evaluation's 2019 development assistance for health database. We estimated total spending on immunisation by aggregating the government, donor, prepaid private, and household spending estimates.

Findings

Between 2000 and 2017, funding for immunisation totalled US$112·4 billion (95% uncertainty interval 108·5–118·5). Aggregated across all low-income and middle-income countries, government spending consistently remained the largest source of funding, providing between 60·0% (57·7–61·9) and 79·3% (73·8–81·4) of total immunisation spending each year (corresponding to between $2·5 billion [2·3–2·8] and $6·4 billion [6·0–7·0] each year). Across income groups, immunisation spending per surviving infant was similar in low-income and lower-middle-income countries and territories, with average spending of $40 (38–42) in low-income countries and $42 (39–46) in lower-middle-income countries, in 2017. In low-income countries and territories, development assistance made up the largest share of total immunisation spending (69·4% [64·6–72·0]; $630·2 million) in 2017. Across the 135 countries, we observed higher vaccine coverage and increased government spending on immunisation over time, although in some countries, predominantly in Latin America and the Caribbean and in sub-Saharan Africa, vaccine coverage decreased over time, while spending increased.

Interpretation

These estimates highlight the progress over the past two decades in increasing spending on immunisation. However, many challenges still remain and will require dedication and commitment to ensure that the progress made in the previous decade is sustained and advanced in the next decade for the Immunization Agenda 2030.

Funding

Bill & Melinda Gates Foundation.

中文翻译：

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按资金来源估算低收入和中等收入国家 2000-17 年常规和补充免疫活动的总支出：财务模型研究

 背景

儿童免疫接种是最具成本效益的健康干预措施之一。然而，尽管其价值众所周知，但全球疫苗的获取仍远未完成。尽管供应方面的限制导致许多卫生系统的疫苗覆盖率不足，但目前还没有对免疫资金情况进行全面分析。我们旨在通过按资金来源和活动类型分类的免疫资金估算来填补这一空白，以突出免疫资金状况并为政策制定提供信息。

 方法

在这项财务模型研究中，我们估算了 2000 年至 2017 年 135 个低收入和中等收入国家（由世界银行确定）的年度免疫支出，重点关注政府、捐助者和自付费用，以及疫苗和运输成本的分类支出，以及常规时间表和补充活动。为了生成这些估计值，我们从国家卫生账户、世界卫生组织-联合国儿童基金会联合报告表、综合多年计划、全球疫苗和免疫联盟、疫苗联盟的数据库以及健康指标与评估研究所的2019年健康发展援助数据库中提取了数据。我们通过汇总政府、捐助者、预付费私人和家庭支出估算来估算免疫接种总支出。

 发现

2000年至2017年间，免疫资金总额为112·40亿美元（95%不确定性区间为108·5–118·5）。在所有低收入和中等收入国家中，政府支出始终是最大的资金来源，提供 60·0% (57·7–61·9) 至 79·3% (73·8–81·4) ）每年的免疫总支出（相当于每年 2·50 亿美元 [2·3–2·8] 到 6·40 亿美元 [6·0–7·0]）。在各个收入群体中，低收入和中低收入国家和地区的每个存活婴儿的免疫支出相似，低收入国家的平均支出为 40 美元（38-42），低收入国家的平均支出为 42 美元（39-46）。中等收入国家，2017 年。在低收入国家和地区，2017 年发展援助占免疫总支出的最大份额（69·4% [64·6–72·0]；630·200 万美元）。在 135 个国家中，我们观察到随着时间的推移，疫苗覆盖率有所提高，政府免疫支出也有所增加，尽管在一些国家，主要是拉丁美洲和加勒比地区以及撒哈拉以南非洲，疫苗覆盖率随着时间的推移而下降，而支出却有所增加。

 解释

这些估计突显了过去二十年在增加免疫支出方面取得的进展。然而，许多挑战仍然存在，需要奉献精神和承诺，以确保过去十年取得的进展在下一个十年得以持续和推进，以实现 2030 年免疫议程。

 资金

比尔及梅琳达·盖茨基金会。