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The Cost of Procuring and Delivering COVID-19 Vaccines in Low- and Middle-Income Countries: A Model of Projected Resource Needs

Background: Ending the COVID-19 pandemic requires effective implementation of vaccination programs in all countries. Information on the cost of vaccine procurement and delivery is paramount for effective planning and budgeting, especially in low- and middle-income countries (LMICs) given their budget constraints. 
 
Methods: We estimated regional and national costs to scale up COVID-19 vaccinations in 132 LMICs under different scenarios. We defined three priority groups: 1) healthcare workers; 2) population at high risk of severe COVID-19; and 3) adults with low risk of mortality and morbidity. We assumed that 70% of the population needs to be vaccinated to reach vaccine herd immunity. We used publicly available data on procurement pricing, delivery costs, and population size. We compared the price tag estimates to the countries’ historical annual immunization spending. 
 
Findings: We estimated a total cost of US$74 billion to reach vaccine herd immunity in LMICs. Of this total, 67% (US$50 billion) is for vaccine procurement, 33% (US$24 billion) is for vaccine delivery, 6% (US$4·2 billion) is to vaccinate high-risk populations, and 0.6% (US$0·46 billion) is to vaccinate healthcare workers. Twenty percent of LMICs have a price tag that is at least 10 times their baseline annual immunization spending. 
 
Interpretation: COVID-19 vaccination will have a major impact on LMIC national healthcare budgets. Substantial investments by governments and donors are needed for vaccine procurement and vaccine delivery infrastructure. 
 
Funding: Duke Global Health Institute pilot grant. 
 
Conflict of Interest: Dr. Dixit reports grants from Bill & Melinda Gates Foundation, outside the submitted work, all other authors have nothing to disclose.