What We Do Not Know about the Costs of Immunization Programs in Low- and Middle-Income Countries
Evidence on immunization economics is a critical input for country immunization programs, particularly in low- and middle-income countries (LMICs) with government- and donor-funded vaccination programs. This evidence allows programs to budget for current services, plan for new vaccine introduction, and evaluate the efficiency of service delivery strategies. Evidence on immunization costs is also useful for international funders when making resource allocation decisions. A large number of studies have reported on the effectiveness and cost-effectiveness of childhood immunization for reducing the impact of vaccinepreventable diseases in LMICs. Nevertheless, these analyses often frame vaccine implementation strategies in general terms and make assumptions regarding costs and operational success. Bias or uncertainty in cost estimates can significantly influence the results of cost-effectiveness and budget impact analyses, and there is a substantial gap in the empirical evidence available on immunization economics. We discuss the nature of this evidence gap, and propose solutions for closing it.