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Portnoy A.,International Vaccine Access Center | Ozawa S.,International Vaccine Access Center | Grewal S.,International Vaccine Access Center | Norman B.A.,University of Pittsburgh | And 8 more authors.
Vaccine | Year: 2015

While new mechanisms such as advance market commitments and co-financing policies of the GAVI Alliance are allowing low- and middle-income countries to gain access to vaccines faster than ever, understanding the full scope of vaccine program costs is essential to ensure adequate resource mobilization. This costing analysis examines the vaccine costs, supply chain costs, and service delivery costs of immunization programs for routine immunization and for supplemental immunization activities (SIAs) for vaccines related to 18 antigens in 94 countries across the decade, 2011-2020. Vaccine costs were calculated using GAVI price forecasts for GAVI-eligible countries, and assumptions from the PAHO Revolving Fund and UNICEF for middle-income countries not supported by the GAVI Alliance. Vaccine introductions and coverage levels were projected primarily based on GAVI's Adjusted Demand Forecast. Supply chain costs including costs of transportation, storage, and labor were estimated by developing a mechanistic model using data generated by the HERMES discrete event simulation models. Service delivery costs were abstracted from comprehensive multi-year plans for the majority of GAVI-eligible countries and regression analysis was conducted to extrapolate costs to additional countries.The analysis shows that the delivery of the full vaccination program across 94 countries would cost a total of $62 billion (95% uncertainty range: $43-$87 billion) over the decade, including $51 billion ($34-$73 billion) for routine immunization and $11 billion ($7-$17 billion) for SIAs. More than half of these costs stem from service delivery at $34 billion ($21-$51 billion)-with an additional $24 billion ($13-$41 billion) in vaccine costs and $4 billion ($3-$5 billion) in supply chain costs.The findings present the global costs to attain the goals envisioned during the Decade of Vaccines to prevent millions of deaths by 2020 through more equitable access to existing vaccines for people in all communities. By projecting the full costs of immunization programs, our findings may aid to garner greater country and donor commitments toward adequate resource mobilization and efficient allocation. As service delivery costs have increasingly become the main driver of vaccination program costs, it is essential to pay additional consideration to health systems strengthening. © 2015 Elsevier Ltd.

Norman B.A.,University of Pittsburgh | Nourollahi S.,University of Pittsburgh | Chen S.-I.,Nestlé | Brown S.T.,Pittsburgh Supercomputing Center | And 6 more authors.
Vaccine | Year: 2013

Background: The challenge of keeping vaccines cold at health posts given the unreliability of power sources in many low- and middle-income countries and the expense and maintenance requirements of solar refrigerators has motivated the development of passive cold storage devices (PCDs), containers that keep vaccines cold without using an active energy source. With different PCDs under development, manufacturers, policymakers and funders need guidance on how varying different PCD characteristics may affect the devices' cost and utility. Methods: We developed an economic spreadsheet model representing the lowest two levels of a typical Expanded Program on Immunization (EPI) vaccine supply chain: a district store, the immunization locations that the district store serves, and the transport vehicles that operate between the district store and the immunization locations. The model compares the use of three vaccine storage device options [(1) portable PCDs, (2) stationary PCDs, or (3) solar refrigerators] and allows the user to vary different device (e.g., size and cost) and scenario characteristics (e.g., catchment area population size and vaccine schedule). Results: For a sample set of select scenarios and equipment specification, we found the portable PCD to generally be better suited to populations of 5,000 or less. The stationary PCD replenished once per month can be a robust design especially with a 35L capacity and a cost of $2,500 or less. The solar device was generally a reasonable alternative for most of the scenarios explored if the cost was $2,100 or less (including installation). No one device type dominated over all explored circumstances. Therefore, the best device may vary from country-to-country and location-to-location within a country. Conclusions: This study introduces a quantitative model to help guide PCD development. Although our selected set of explored scenarios and device designs was not exhaustive, future explorations can further alter model input values to represent additional scenarios and device designs. © 2013 Elsevier Ltd.

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