Key takeaways

  • On average, the countries in focus spend 0.08% of their GDP on immunisation, and less than 1% of healthcare expenditure. The current magnitude of spending may be too low given the growing evidence of the societal and economic value that successfully implemented immunisation programs can deliver.
  • Coverage rates for key vaccines remain below WHO targets, particularly affecting adult vaccination programs.
  • Reviewing and improving vaccine delivery systems across age groups can improve coverage rates and program efficiency in resource-constrained settings.
  • Data gaps across age groups and programs severely limit effective policy-making, resource allocation, and program monitoring.
  • Strategic approaches are needed to both increase absolute immunisation funding and protect these budgets from economic fluctuations.

They are a safe and cost-effective strategy to save lives and reduce long-term health care costs, while also providing broader societal economic impacts. The latter impact has been most clearly demonstrated by COVID-19 vaccination programmes, which facilitated the easing of stay-at-home measures, enabling economic recovery and the reintroduction of social and workplace activities.

Despite their proven societal and economic benefits, funding for immunisation programmes remains disproportionately low and vulnerable to economic shocks. As a form of prevention, immunisation helps stop diseases before they occur, complementing other preventative measures such as health education and early disease detection (e.g. screening). As such, funding immunisation requires making investment decisions today to secure potentially large long-term benefits.

To inform related decision-making processes, this summary outlines key findings, trends, and actionable recommendations based on an analysis of prevention and immunisation spending as well as vaccine-preventable health outcomes and coverage over the period of 2016 to 2022 across ten countries (Australia, Brazil, Canada, France, Germany, Italy, Japan, Mexico, South Korea and the United Kingdom).

Key Findings

Low spending on immunisation contrasts with the value of immunisation

Immunisation expenditure averages only 0.08% of GDP among analysed countries. This is low compared to healthcare spending, with mean immunisation expenditure being just 0.3% and 0.7% of overall health care expenditure during the period 2016-2019 and 2020-22, respectively. Funding for immunisation is often among the first to be cut during economic downturns, jeopardising public health resilience.

COVID-19 temporarily boosted immunisation budgets, with some countries quadrupling their spending between 2016-19 and 2020-22. However, this was in response to a global health emergency and is not indicative of future investment into immunisation.

The level of spending on immunisation is at odds with the evidence regarding the value of immunisation. This analysis shows that a $100 per capita increase in immunisation spending (prior to 2020) correlates with three fewer vaccine-preventable deaths per 100,000 people. The evidence in this report supports the growing evidence base that investment in vaccination programmes is a highly valuable healthcare policy intervention. Previous research showed that adult immunisation programmes can deliver up to 19 times their cost in societal value, underscoring their economic efficiency and welfare creating potential.

Nevertheless, gaps in coverage persist. This report monitored coverage rates for three key programmes with comprehensive data reporting (adult influenza, adolescent HPV and child measles). Many countries in the analysis do not achieve the WHO’s 95% target for childhood measles, 90% for HPV, or 75% for adult influenza vaccines. Variation in vaccine coverage and programme availability exists, with adult immunisation in particular remaining underfunded and underreported. Many other key programmes do not regularly report and publish data on coverage, both for adult programmes (such as COVID-19, pneumococcal and herpes zoster) and adolescent programmes (such as meningococcal).

Data gaps hinder effective policy-making and monitoring

Data on immunisation spending by age group and programme is limited, and coverage data for adult vaccines, such as COVID-19, pneumococcal, herpes zoster, and influenza, is also suboptimal. Among these, influenza has the most comprehensive reporting. These data gaps obscure areas of high-need and opportunities for improvement.

Policy Recommendations

Prioritise valuable immunisation programmes: We call on Governments to re-assess whether their national immunisation budgets are adequate to unlock the full value potential of a life-course immunisation approach. Increasing the overall share of immunisation spending as a proportion of healthcare spending and of GDP should actively be considered.

Increase and stabilise funding: We recommend that Governments review approaches to increase and protect budgets for prevention and immunisation.

  • Strategic approaches should be explored to increase immunisation funding in absolute and relative terms. A novel prevention investment standard could address the comparative underfunding of vaccination.
  • Prevention budgets must also be sustained to ensure consistent and adequate financing. Establishing dedicated prevention funds can safeguard immunisation programmes from economic fluctuations.

Enhance programme effectiveness: The effectiveness of programme delivery plays a crucial role in its success where public resources are constrained. Policymakers should review how vaccines are delivered to help improve coverage rates and deliver a more efficient programme, recognising that different approaches may be needed for adult, adolescent, and child programmes.

  • Expanding vaccination options, including administration in pharmacies, could improve access, better meet population needs, and reduce pressure on other primary care services.
  • Integrating vaccination into routine health care services, such as annual check-ups or chronic disease management, can improve accessibility and uptake.
  • Adopting digital health tools, including electronic vaccination records and reminder systems, can streamline programme delivery and enhance data accuracy.

Improve data collection and reporting: Improved data collection is required to identify and enable focus on areas requiring additional support and resources, in particular for adult vaccination programmes, to maximise the health and broader economic impact.

  • Health systems should report disaggregated data on immunisation expenditure by adult, adolescent, and paediatric, as well as by vaccine type, to enable targeted resource allocation.
  • Enhanced morbidity and mortality tracking related to vaccine-preventable diseases can provide a more comprehensive picture of immunisation programme’s impact.

Conclusion: By addressing funding gaps, implementing data-driven strategies, and promoting equitable access, healthcare and finance policymakers can build resilient healthcare systems that deliver long-term health and economic benefits. Immunisation is not only an effective health care intervention but a strategic investment in national prosperity and biosecurity. Further research is needed to evaluate the appropriate levels of funding required which reflect the value of immunisation.

 

This report ‘Analysing Global Immunisation Expenditure’ was commissioned and funded by Pfizer.

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