Underpinning the whole immunisation system – such as existing and new vaccines, supply chains, health workers, clinics, outreach programmes, etc. – is funding.
Many countries, though, struggle to find adequate, stable and sustainable funding for immunisation. Budgets are too often insufficient or not secured with a clear budget line. New vaccines are increasingly expensive. Reaching the unreached children (and adults) with vaccines is not an easy task, and will take money. When Gavi funding ends, countries will need to replace that financing, often in creative ways.
As advocates, one of the most important things we can do to ensure there is change, that problems are addressed and opportunities for improvement are seized, is to understand how financing for immunisation is done, and by whom. Then we can help to shape that funding now and in the future.
Gavi co-financing and graduation: sustaining vaccines in the long run
Gavi has a policy of co-financing for most of the vaccines it supports, which means countries are expected to pay a portion of the costs of the vaccines, on a rising scale as the country’s Gross National Income (GNI) increases.
When a country’s GNI reaches Gavi’s criteria, the country begins the process of ‘graduation’ from Gavi support. It is important that alternative sources of funding – within the government or outside – are found to carry forward the immunisation system and vaccines to future generations of children.
How decisions are made for vaccine funding
Understanding your country’s budgetary processes and funding for immunisation will help you ensure the funding is strong, secure and sustainable. You can also help your government in identifying existing or new resources for immunisation.
Here are examples of how different government departments share responsibility for making decisions around vaccines and immunisation, but you will need to map the roles and responsibilities in your country.
Determines funding priorities for the health sector, including immunisation and vaccines.
Works with the Ministry of Health in setting and monitoring the budget for immunisation and vaccines; determining budget lines for immunisation; and ensuring sustainable financing.
In some countries, the budget for health issues is controlled or managed at a sub-national level. It is important to understand the situation in your country.
These officials, politicians and government bodies may be asked to approve or pass budgets, and can be influential regarding what is prioritised and included.
Considerations for funding vaccines
- How does this burden of disease compare to other public health or immunisation priorities?
- What other critical national priorities may be taking precedent?
- What is the cost of the vaccine when balanced against the cost of treatment of the disease?
- What is the broader impact of the vaccine on society and the economy, or the ‘value of vaccines’?
- What, if any, public opinion or interest is there in funding this vaccine and in supporting a strong immunisation system?
- What is the Ministry of Health and/or national budget for immunisation?
- Is there a comprehensive multi-year plan (cMYP) and dedicated budget line for immunisation?
- What are the current and future sources of funding?
Financial sustainability of vaccines and immunisation
- What funding is available through Gavi or other sources for specific vaccines and immunisation, and for how long?
- What is the funding gap between what is available and what is needed?
- How will they be sustained after graduation, when Gavi funding is reduced/ends? When does the country graduate from Gavi funding?
- What other sources of funding exist or could fill the gap? (National budget, external sources, private sector, etc).
How you can advocate for immunisation funding
Now that you have a better understanding of who makes decisions, how the budget is developed and by whom, what can you do to influence financing for vaccines and immunisation?
There are a number of concrete steps you can consider. For example, here are some issues to explore and discuss with decision makers and those in a position to influence the budget:
Understand your country’s existing budget for the immunisation system and vaccines. Is it adequate? What more is needed? Can new vaccines be introduced with this amount of money?
Check your country’s budget to see if there is a dedicated budget line for the cMYP. That is an important way to secure funding for immunisation and vaccines each year.
If your country receives Gavi funding, is it scheduled for graduation? If so, when? And what plans are being put in place to develop alternative sources of funding?
Whether your country gets Gavi funding or not, has your government explored alternative sources of funding, such as donors, the private sector, innovative financing mechanisms or taxation measures?