Economic studies have shown that immunization is an excellent investment, yielding one of the highest returns in health. One dollar spent on immunization is estimated to generate a $16 return on investment. UNICEF considers governments’ budget allocations, whatever their resources, to this life-saving intervention to be states’ foremost commitment to children and the fulfilment of their obligations under the Convention on the Rights of the Child (CRC). Yet, protecting immunization in governments’ budgets has not been systematically addressed in middle-income countries in the Middle East and North Africa (MENA) region.
It is to help governments uphold their commitments to the right of every child to be immunized against preventable diseases that UNICEF has undertaken the present financing study. Based on data, research, interviews, lessons learned and good practices in the MENA region, the study provides policymakers, senior officials in ministries of finance and health, and parliamentarians or equivalents with a set of key recommendations to secure necessary government financing for this critical childhood intervention.
In focusing on middle-income countries, the study provides a deeper understanding of the situation and dynamics of two critical subgroups:
- countries with gross national incomes per capita too high to make them eligible for outside financial support, yet who face challenges to meet their immunization goals; and
- countries eligible for international development assistance, yet who struggle to transition out of aid and co-finance a much greater share of their immunization costs.
That means prioritizing health within government budgets, prioritizing immunization within health, and working to make programmes as efficient as possible.
Key global players are at the vanguard of the immunization drive, including by making newer vaccines accessible to countries facing resource constraints. Gavi, the Vaccine Alliance, plays a central role in giving eligible countries support to adopt new, life-saving vaccines and improve coverage and equity. At UNICEF, the Supply Division makes every effort to source and supply affordable vaccines, making its procurement services available to countries.
Gaining efficiencies and ensuring sustainability are two overarching themes of immunization financing in this report. Where and how countries spend on health is critical: do they allocate funding to ‘do the right thing’ – using budgets to adequately support the highest priority activities in health, such as immunization? And are they ‘doing things right’ – delivering high-quality services and procuring vaccines efficiently? Do budgets include ancillary but crucial allotments for ongoing supervision, training, surveillance, supply and cold chain management, and laboratory control that are prerequisites for effective immunization?
This report concludes that in most of MENA’s middle-income countries, prioritizing immunization and making it more efficient is the best way to create room in budgets and to secure more resources. Many of the recommended first steps are information-related: generating and sharing knowledge, equipping policymakers with evidence, and determining the role of social insurance.
It is our hope that this report and its recommendations will help UNICEF and partners in the region strengthen their advocacy and support to governments so they live up to their commitments to the CRC and build high-performing immunization systems that are accessible to all.