FAQs on COVID-19 Vaccination Costing

Why should the COVID-19 vaccination costing be done?

• Credible and realistic estimation of multi-year costs of COVID-19 vaccination roll-out plans is an important step in the budgeting and financing process and is critical for ensuring that the health and economic objectives of vaccinations are realized without harm to existing essential health services.
• There are several purposes for cost estimates. First, the cost estimation can identify and value resource needs and resources available, and thus gaps to inform domestic resource mobilization and, where necessary, request for external funding.
• Second, the process of cost estimation can be used to optimize delivery strategies and coverage scenarios to minimize the financial needs and health systems burden (such as human resources for health needing to be redeployed). This is best achieved when the costing process brings together all the relevant COVID-19 vaccination stakeholders to have a dialogue on various realistic scenarios (e.g., target population definitions, prioritization, delivery modalities, and vaccine product selection) are deliberated upon.
• Third, as the various components of costs are estimated, this allows specific bottlenecks and financial gaps to be identified, areas where there is unavoidable uncertainty (such as vaccine procurement prices and expected demand) to be clarified, and for public financial management considerations (such as key budget holders and the time dimension for liquidity needs) to be identified.
• Finally, if done in a manner integrated with existing routine immunizations and/or other essential health services, costing for COVID-19 vaccination in the context of existing health programmes can facilitate a scale-up of COVID-19 vaccination which is protective of essential health services.

When should the COVID-19 vaccination costing be done?

• The estimation of costs should begin as early as possible and form a core component of the National Deployment and Vaccination Plan (NDVP) to ensure feasible and affordable plans. Scale-up planning, costing, and budgeting are iterative and interrelated processes and should be timed, as far as possible, with the budget cycle so that it can inform budget negotiations (usually six months before the relevant fiscal year).
• As cost estimation and NDVP development are dynamic processes, the NDVP and cost estimate should be regularly updated to reflect the developing pandemic context, vaccine supply, lessons learnt through Intra-Action Reviews (IARs) and Post-Introduction Evaluations (PIEs), and the health systems context of the country.

How should the COVID-19 vaccination costing be done?

• The estimation of costs needs to be done credibly, transparent and based on key components and elements, taking into consideration the various strategies being proposed, to ensure that the vaccines reach the target population optimally. It should cover the necessary cost categories or inputs that linked to the COVID-19 vaccination (such as salary of vaccinators, PPEs, vaccines, cold chain etc.).
• Various tools and templates are available for costing. Countries can develop their costing plan using such tools or templates. However, a COVID-19 vaccination specific costing tool, WHO-UNICEF COVID-19 Vaccine Introduction and deployment Costing (CVIC) tool, that is developed in alignment with the NDVP and WHO SAGE priority framework for COVID-19 vaccines offer robust think through of the process.
• Get the data: Most information on costs and funding should be obtainable at the national level. But you will need to gather numbers from many sources, including the Ministry of Health, the Ministry of Finance and international donors. You may need to communicate with sub-national levels (districts). Sub-national data (for example, from district microplans) may help increase accuracy and reliability of cost estimates and will be important in developing the budget. Even at the national level, the information you need is rarely all in the same place. To get the numbers, you may have to dig through expenditure records, invoices and supply and procurement files. Reliance on previous cost for similar exercise like Supplemental Immunization Activities (SIAs) for Measles or polio vaccination may be helpful.

What components should be included in COVID-19 vaccination costing and why?

• Country should not only cost areas which require donors’ support but cost the entire envelope of resource needs.
• According to the guidance on developing a NDVP for COVID-19, a country costing plan on COVID-19 vaccination should include at least nine common cost categories and associated subcategories. They are: (1) Cross-cutting Technical Assistance for Planning, Coordination and Delivery; (2) Vaccine Doses and Related Devices & Supplies; (3) Vaccinators; (4) Vaccination Delivery; (5) Cold Chain; (6) Data Management, Monitoring & Evaluation, and Oversight; (7) Vaccine Safety Surveillance and Injection Safety ; (8) Demand Generation and Communications; (9) Protecting Essential Health Services and Health Systems Strengthening.
• The approach should be comprehensive and focused on the range of inputs required to effectively deliver COVID-19 vaccines to specific target populations. A costing tool, like CVIC also helps to make assumptions transparent and debatable. With the CVIC tool, countries can perform scenario analyses and analytics such as identifying the cost drivers and determine which is the most important component and to optimize delivery strategies. It also allows easier update of the cost estimates for different scenarios or for scaling-up of the vaccine if new vaccine formulations become available and/or evidence on COVID-19 transmission and epidemiology is being updated.

Do I need to know all costs of all items and inputs to use CVIC?

No, for the facilitation of estimates there are available databases of standardized costs of some standard input costs such as PPEs, vaccines, logistics or cold chain which could be found online (e.g., the UNICEF SD) or some country level estimates of costs of service delivery based on other vaccine deployments. The more country-specific data on costs available, the better, but for the meso-level costing a lot of assumptions can be used based on expert knowledge and experience.

How can a costing tool help with the process of COVID-19 vaccine roll-out?

A costing tool is not just speaking out numbers but to inform planning and decision-making discussions among stakeholders including different national budget holders, external funders, etc. Different budget holders may be of interested in different cost components. The CVIC tool also allows thinking through the plan for scale-up of vaccination, such as determining the quantities needed for different components, target population, coverage rate, vaccination strategies/ delivery modalities. In addition, with the level of details in the costing process, costs for different time period (year 1, year 2 and year 3) could also be determined. 

From whom can a country get help with COVID-19 vaccination costing?

WHO, UNICEF and various partners are supporting countries in the use of CVIC tool. One-to-one country support and global trainings (available in English and French) have been provided. A CVIC introductory video has been developed to show the importance of costing of COVID-19 vaccination and the role of CVIC. A CVIC step-by-step written user guide and demonstration/training videos through OpenWHO will be available. The team is available through CVICosting@who.int.

Is actual spending needed to be tracked after budget is approved?

Yes, countries are encouraged to track and monitor the actual spending to ensure timely and effective implementation of national vaccination roll-out. Good financial management for tracking resources utilization is essential for a country to make efficient use of the fund/ resources and make sound decisions.

Why should we load the CVIC tool up to the WHO COVID-19 Partners Platform once ready?

• Countries can submit request of their resource needs to the WHO COVID-19 Partners Platform through uploading a completed CVIC version 2.1 or entering manually. The cost categories for technical assistance and funding resource requests through the platform are in line with the CVIC tool.
• In order to support countries, partners and funders will be able to assess and benchmark financial implications and resource requirements of NDVPs against standardized estimates and make prioritizations and other decisions.