Collaborating for sustainable immunization financing in Africa

On July 31, 2024, the VacciNations Campaign—an initiative by PATH, the Gavi CSO Constituency, and WACI Health to address the urgent challenge of ensuring sustainable funding for routine immunization programs in Africa—hosted a regional dialogue on immunization financing, "A Deep Dive into Financing for Routine Immunization in Africa." The event brought together experts, advocates, and government officials from across the continent to discuss strategies to overcome financial and logistical barriers to ensure lifesaving vaccines reach every child.

Vandana Shah from the Global Health Advocacy Incubator (GHAI) underscored the importance of sustained advocacy in influencing government budget allocations for routine immunization. She highlighted that while some countries have increased their overall health budgets by up to 12 percent, the proportion allocated to immunization often remains alarmingly low—less than three percent in many cases. Shah also highlighted the pivotal role of civil society organizations (CSOs) in driving transparency and accountability.

Keightley Reynolds from Gavi, the Vaccine Alliance, delivered a passionate call to action, urging all stakeholders to prioritize immunization financing across Africa. She stressed the need for African countries to develop financing models that reduce dependence on donor funding and highlighted the crucial role of collaboration in achieving lasting success.

The session featured deep dives into country-specific experiences from PATH’s work. First,  Dr. Mike Mulongo, a health financing specialist who consulted with PATH to write Analysis of progress towards sustainable financing of immunization presented a detailed analysis of the disparities in immunization financing across Nigeria, the Democratic Republic of Congo (DRC), and Ethiopia. Dr. Mulongo provided a stark overview of Nigeria, where only two percent of the health budget is dedicated to immunization—a troubling statistic given the country’s large population and significant vaccine needs.

"Such low allocations are insufficient to ensure widespread vaccine coverage, particularly in a country as populous as Nigeria," Mulongo says.

Turning to the DRC, Dr. Mulongo described how political instability has further strained immunization efforts, with less than one percent of the national budget earmarked for these critical programs. Dr. Mymy Mwika, an immunization officer at PATH based in Kinshasa, explained that routine immunization is frequently disrupted in conflict-affected areas, leading to outbreaks of vaccine-preventable diseases. With immense challenges facing the DRC, investing in health to build resilient systems capable of operating effectively, even in unstable environments, through innovative funding mechanisms and robust partnerships are crucial to maintaining the country’s immunization programs.

In contrast, Ethiopia can serve a beacon of hope for the region, where strategic partnerships and focused advocacy have led to gradual improvements in immunization funding, blending international aid with increased domestic investment.

Diriba Bedada, project director for PATH’s Vaccine and Immunization Program in Ethiopia, spoke candidly about the challenges Ethiopia faces in securing domestic investment for immunization programs, highlighting the difficulties of resource allocation and financial constraints, particularly the struggle to make fair share contributions in local currency due to limited foreign exchange reserves. Despite these hurdles, Diriba emphasized the government's commitment to the cause, with investments in health infrastructure and workforce supported by high-level leadership at the Ministry of Health proving critical in maintaining and advancing Ethiopia's immunization efforts, which Diriba described as a "litmus test" for the overall strength of the country's health system.

Finally, Dr. Aminu Magashi Garba from the Africa Health Budget Network added another dimension to the discussion by focusing on the importance of accountability in government spending on immunization. He highlighted Uganda as a case study where relentless advocacy led to a 15 percent increase in immunization funding over the past five years, demonstrating the power of consistent, targeted efforts.

The webinar led to several recommendations:

1. Increase immunization budget allocations: Across the continent, immunization often receives less than three percent of national health budgets, as seen in Kenya and Nigeria. There is a pressing need for governments to allocate more resources to meet the growing demand for vaccines.
2. Build resilient health systems: Countries like the DRC, where political instability disrupts routine immunization, need to focus on building resilient health systems that can withstand such challenges.
3. Enhance accountability and transparency: Governments should collaborate more closely with CSOs to ensure transparency in the use of immunization funds, track expenditures, and ensure that allocated funds are effectively utilized.
4. Develop sustainable financing models: It is crucial that governments reduce dependency on donor funding by developing sustainable domestic financing models. Ethiopia and Uganda’s strategies offer valuable lessons in this regard.
5. Leverage public-private partnerships: Governments should explore public-private partnerships to bridge the immunization financing gap and improve vaccine coverage.

The regional dialogue underscored the urgent need for a collaborative approach to secure sustainable financing for routine immunization in Africa. Increased domestic investment, enhanced transparency and accountability, and strategic advocacy are essential to ensuring that every child receives the vaccines they need. As Africa continues to confront significant public health challenges, the success of its immunization programs will depend on the unwavering commitment and cooperation of governments, civil society, and international partners.