Estimating the additional cost for maintaining facility-based Routine Immunization programs in the context of COVID-19

Incremental financial cost of COVID-related modifications to routine immunization One-time startup costs per facility range from $400 per facility up to $1,660 per facility, depending on the modifications adopted. Recurrent costs range from $450 to just over $1,000 per facility each month that modifications are in place, highlighting the importance not only of considering the scope of modifications required in a specific country context, but also the potential duration that they might be required. Combining startup and 12 months of recurrent costs would total $6,000 to $15,000 per health facility, depending on the program modifications implemented. For LMICs, considering additional costs of PPE and training/social mobilization, the per-facility cost represents a 3–14% increase from baseline delivery costs, depending on the intensity of program modifications. When including the additional labor cost of crowd controller/intake screening personnel, the cost increases to 23–53% of baseline delivery costs. Finally, adding in the additional cost of hazard pay for health workers would translate to an approximately 36–94% increase over baseline delivery.