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Table 2 Weighted Average per person per dose operational costs by vaccine/grouping and size of the country, 2004–2011 – Analysis of cMYP data

From: Updating the evidence base on the operational costs of supplementary immunization activities for current and future accelerated disease control, elimination and eradication efforts

Vaccine/grouping All countries N Small countries (<10 m) N Min ‡ Max§ SD Mid-size & large countries (≥10 m) N Min ‡ Max§ SD
OPV $0.40 53 $0.54 22 $0.14 $1.97 $0.42 $0.39 31 $0.02 $1.77 $0.29
Tetanus vaccines $0.29 26 $0.80 7 $0.02 $1.83 $0.32 $0.27 19 $0.02 $0.76 $0.13
Measles vaccines $0.81 38 $1.30 13 $0.27 $3.73 $0.68 $0.79 25 $0.13 $3.55 $0.57
Vaccines in GAVI’s portfolio $0.98 51 $1.07 17 $0.05 $9.52 $1.44 $0.98 34 $0.03 $3.55 $0.69
Oral vaccines/interventions $0.39 63 $0.46 27 $0.10 $1.97 $0.42 $0.39 36 $0.004 $1.77 $0.33
Injectable vaccines $0.77 79 $0.98 24 $0.02 $9.52 $1.45 $0.76 55 $0.02 $3.55 $0.73
All vaccines/interventions   142   51      91    
  1. Additional notes.
  2. N→Number of observations.
  3. SD→Standard Deviation.
  4. ‡→Minimum values: In terms of the frequency of occurrence of extremely low values, of the 142 country observations in the dataset, 8% (n=12) of the country observations below $0.10. Seven of these instances related to SIAs for orally administered vaccines/intervention for which we would expect lower costs, and three were for tetanus vaccine SIAs which, on average, have lower operational costs in any case. A sensitivity analysis indicated that removing these observations did not significantly change the findings. While it’s possible that the extremely low values could signify errors in the country plans, these were included in the analyses because they seemed plausible. From an analytic perspective, where low values were observed, we compared these within a countries’ cMYP across diseases, and over time. In the majority of cases where the operational costs were low, the estimates were consistently low suggesting that these were not errors. From a programmatic and budgetary/planning perspective, there are a variety of possible explanations; e.g. reliance on partners or CSOs to conduct (aspects of) the campaign without needing to acknowledge these in the budget; re-programming existing health sector staff to conduct campaign (e.g. making nurses vaccinate children during the SIA) without this shared cost featuring in the immunization budget; reliance on unpaid personnel to conduct campaign (e.g. community health workers to undertake campaign vaccination). It is not uncommon for immunization costing studies to overlook donated costs including that of volunteer time [47].
  5. §→Maximum values: Similarly, while it’s possible that the extremely high values could signify errors in the country plans, these were included in the analyses again because they appeared plausible. 9% of the dataset (n= 13 occurrences) where average operational costs were greater than $1.50 per person. Of these, five were in very small countries (e.g. Cape Verde, Djibouti, Kiribati); two involved vaccines not usually administered through mass vaccination and/or very specific target groups (i.e. typhoid vaccines for food handlers in schools, Hepatitis B targeting special risk groups), and all bar-one were conducted in the African region where per diems often raise the average SIA costs (See below for further details).