Global recognition of the vaccine access challenges facing middle-income countries is increasing. The introduction and sustained coverage of newer vaccines—e.g., pneumococcal conjugate vaccine (PCV), rotavirus vaccine, and human papillomavirus (HPV) vaccine—is lagging in many of these countries, largely due to cost constraints.
PATH's new Vaccine Cost Calculators for PCV and rotavirus vaccine aim to help country-level decision-makers specifically in middle-income countries compare products and estimate vaccination program costs for different vaccine options. These simple, Excel-based tools aim to help with decision-making to support the introduction and continued use of these important vaccines.
For middle-income countries that have already introduced PCV or rotavirus vaccine, the calculators can also help with decision-making about potential switches to a new vaccine product or scenario planning for using a combination of products.
Unique vaccination challenges
Millions of under immunized children live in middle-income countries that are no longer eligible for donor support for immunization. While some international funding is available to these countries, overall donor support remains limited, placing the responsibility for routine immunization and new vaccine introduction financing squarely on local policymakers. This is on top of numerous other costly challenges they must give their attention to, such as climate change, economic crises, and rapid urbanization.
The potential impact of improving immunization in middle-income countries, particularly those not eligible for or that have transitioned out of support from Gavi, the Vaccine Alliance, is substantial. Modeling suggests that the introduction of PCV, rotavirus vaccine, and HPV vaccine in these countries in 2020 could have saved an estimated 70,000 lives if 90 percent coverage was reached. And approximately 29 million children living in non-Gavi-eligible middle-income countries do not have access to at least two of these three vaccines.
“Our original suite of Vaccine Cost Calculators, launched in 2020, were designed to be useable by any country, whether or not they were eligible for Gavi support,” said Frédéric Debellut, a senior health economist in PATH’s Center for Vaccine Innovation and Access. “However, we realized that the needs of middle-income countries differed from those of Gavi-eligible countries, and that more flexible tools tailored to their unique needs would be helpful.”
Fit-for-purpose features
PATH’s new Vaccine Cost Calculators aim to help middle-income country policymakers with important vaccine introduction and product switch decisions by calculating cold chain volume and costs annually and for a total period of five years. The calculators are currently available for PCVs and rotavirus vaccines and can be downloaded in English, French, and Spanish.
These new tools offer a fresh, streamlined design and allow users to compare the financial costs of PCV or rotavirus vaccination programs with each vaccine product available in the global market (including those no longer available to Gavi-eligible countries). Up to four different vaccine options can be explored at the same time, some of which policymakers may not even have known were an available option.
This visual of the Rotavirus Vaccine Cost Calculator for Middle-Income Countries shows some of the fields where users are able to input their own data. Photo: PATH
“One important new feature is the ability to add a vaccine option that isn’t available in the global market,” says Debellut. “Some middle-income countries have robust in-country vaccine development and manufacturing capabilities, which means they may have domestically produced vaccine options to consider that aren’t available in other countries. This new level of flexibility is tailor-made for countries who aren’t limited to the Gavi vaccine menu.”
Another new, optional feature of these calculators is the ability to compare costs for up to three different scenarios of multi-vaccine use. Some countries may anticipate using more than one product in their vaccination program at the same time. These calculators offer the ability to compare the cost of programs involving up to four different vaccine options with varying proportions for each vaccine product.
Results are displayed in a summary dashboard for both the main analysis and optional scenarios, as well as more detailed year-by-year estimates for the number of doses delivered, doses and cold chain volume required, vaccine cost, and vaccination program costs. Both the dashboard and detailed results incorporate conditional formatting to visually highlight which vaccine options will be most and least beneficial for the country as far as overall volume or cost.
“It’s important to note that cost is only one consideration when selecting a vaccine product, and users involved in decision-making around new vaccine introductions and switches should always consider other dimensions as well,” cautions Debellut. “In addition, while these modeling tools can provide helpful insights into the potential costs of alternative product choices, this exercise should not replace detailed budget planning once a product has been selected.”
Supporting informed vaccine decision-making
When a country’s status shifts to middle-income designation, this suggests positive economic progress. However, for some countries, this change can come with a host of new challenges, including ensuring continued growth of their national immunization programs in an affordable way. Many middle-income countries continue to need donor support to maintain and grow their immunization programs.
PATH’s newest set of Vaccine Cost Calculators provide a valuable tool to support independent and informed decision-making in middle-income countries around implementing and optimizing PCV and rotavirus vaccination programs.
