Costs of routine immunization and the introduction of new and underutilized vaccines in Ghana
Introduction
Multiple additional vaccines are currently being introduced into routine immunization programs in countries that are eligible for funding from the Global Alliance for Vaccines and Immunization (GAVI). However, many countries are unable to raise sufficient resources, both domestic and external to achieve their objectives [1]. Furthermore, the full cost of new vaccines, plus their distribution and storage costs, remains high for many governments [2] and support for new vaccines in many developing countries remains overwhelmingly dependent on GAVI financing [3]. In addition, new vaccine introduction costings tend to overlook non-vaccine costs [4], [5].
In the African region, Ghana has been a leader in introducing new vaccines into routine immunization programs, expanding from 7 vaccines in 2002 to 12 vaccines in 2013. Ghana was one of the first countries to introduce the pentavalent vaccine (in 2002). Most recently, it has simultaneously introduced pneumococcal conjugate vaccine (PCV), rotavirus vaccine, and measles second-dose (MSD). It has also made substantial investments to ensure new vaccine delivery such as cold chain capacity expansion.
Nevertheless, costs have not been fully assessed, and have focused mainly on resource requirement projections. The latest official information available can be extracted from the 2010–2014 comprehensive multi-year plan (cMYP) [6]. The estimate of the projected cost for routine immunization in 2011 was US$ 32 million [6]. A costing study by Levin et al. [7] conducted in 2000 estimated the total cost for routine immunization at US$ 5.1 million, corresponding to US$ 9.7 for each fully immunized child (FIC) – i.e., three doses of diphtheria-tetanus-pertussis (DTP), hepatitis B, and Haemophilus influenzae type b (Hib) – and a cost of US$ 0.26 per capita, adjusted for inflation.
This study was part of the Expanded Program on Immunization Costing (EPIC), a multi-country analysis of the costs and financing of routine immunization programs and new vaccine introduction, which was supported by the Bill and Melinda Gates Foundation. The project encompassed Benin, Ghana, Honduras, Moldova, Uganda, and Zambia. This manuscript focuses exclusively on the costs of routine immunization and new vaccines introduction.
Section snippets
Methods
The study evaluated the national routine immunization program in 2011 and new vaccine introduction in Ghana from the perspective of the government health service. The following vaccines were part of Ghana's routine immunization schedule in 2011: Bacillus Calmette-Guerin (BCG), pentavalent DTP-hepatitis B-Hib, polio, measles first-dose, yellow fever, and tetanus toxoid (for pregnant women), which represent nine doses per FIC (see Appendix 1). With the introduction of pneumococcal conjugate
Results
The total national aggregated RI costs amounted to US$ 53.4 million in 2011, accounting for 5.21% of general government expenditure on health and 0.14% of the gross domestic product [16]. The aggregated RI cost per routine dose administered was US$ 5.7 (total doses administered: 9,464,165). In comparison, the cost per FIC was US$ 60.3 (the number of children that received a third dose of DTP-HepB-Hib: 887,086) [17]; the cost per infant population was US$ 52.9 (the infant population: 1,011,012);
Discussion
Our EPIC study represents one of the most thorough attempts to evaluate the costs of national routine immunization programs in Ghana and in other countries for the companion studies from this issue [5], [28], [29], [30], [31]. In Ghana, we found that total national costs and costs per FIC were high due mainly to delivery costs, and within non-vaccine costs mainly to employee salaries. Most non-vaccine costs were incurred at the facility level. Costs varied by a factor of three depending on the
Contributors
A common methodological approach and generic questionnaire was developed by the Bill and Melinda Gates Foundation (BMGF). JBLG adapted the questionnaire to the Ghana context following a pre-test of the questionnaire and meetings with Ghana EPI staff and the MOH. JBLG conducted the cost analysis, and report and manuscript writing. MA was in charge of survey implementation and data entry, supervised the interviewers, and provided input on sampling. FN was the interface between the country's
Acknowledgments
We would like to acknowledge the following individuals who contributed to the study: The Ghana Health Service, in particular, KO Antwi-Agyei (Ghana Health Service/EPI), John Frederick Dadzie (Ghana Health Service/EPI), and Dan Osei (Ghana Health Service, PPME), who facilitated and provided guidance for study implementation and analysis. We would also like to acknowledge the interviewers who collected the data: Gustav Togobo, Irene Hamba, Seth Adjei, Bernard Achampong, and Vida Gyasi. Darwin
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