Costs of delivering COVID-19 vaccine in Botswana during the height of the pandemic: a retrospective study

Abstract Background The development, distribution and delivery of COVID-19 vaccines following the outbreak of the global coronavirus pandemic in February 2020 is the largest global immunization action in history. To assist with planning and resource mobilization efforts, a global-level model was use...

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Main Authors: Kelsey Vaughan, Onalenna T. Mokena, Goabaone Rankgoane-Pono, Moses Keetile, Ulla Kou Griffiths
Format: Article
Language:English
Published: BMC 2025-03-01
Series:BMC Health Services Research
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Online Access:https://doi.org/10.1186/s12913-025-12455-9
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author Kelsey Vaughan
Onalenna T. Mokena
Goabaone Rankgoane-Pono
Moses Keetile
Ulla Kou Griffiths
author_facet Kelsey Vaughan
Onalenna T. Mokena
Goabaone Rankgoane-Pono
Moses Keetile
Ulla Kou Griffiths
author_sort Kelsey Vaughan
collection DOAJ
description Abstract Background The development, distribution and delivery of COVID-19 vaccines following the outbreak of the global coronavirus pandemic in February 2020 is the largest global immunization action in history. To assist with planning and resource mobilization efforts, a global-level model was used to estimate expected COVID-19 vaccine delivery costs employing data from the literature on childhood and adult flu vaccine delivery. However, country-level studies were needed to validate these estimates, learn lessons for future pandemics, and plan for forthcoming COVID-19 vaccination of priority groups. Methods We tested several methodological innovations to estimate total costs and costs per dose of COVID-19 vaccine delivery in Botswana. Costs incurred by all government sectors, parastatals, donors, and non-governmental organizations were included. Both fiscal costs (financial outlays) and the value of selected, existing human resources and donated vaccines (economic costs) were included. Results Fiscal delivery costs of COVID-19 vaccination were estimated at US$49.8 million for a 13-month period, with over half accounting for newly hired human resources. Newly hired staff supported not just vaccine delivery, but also co-ordination and social mobilization efforts. The value of existing human resources deployed to support COVID-19 vaccination was US$36.6 million. Based on 2.6 million doses delivered, the fiscal and economic delivery cost per dose was US$19 and US$33, respectively. Vaccines were procured and donated at an average price per dose of US$13.46, increasing the economic cost per dose delivered to approximately US$47. Conclusions In Botswana, costs were substantially higher than modelled estimates for COVID-19 vaccine delivery and the costs of delivering routine childhood vaccines. This suggests that rolling out a new vaccine to an entire population in the middle of a pandemic requires additional financial investments beyond what has been typical for immunization services in the past.
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spelling doaj-art-3f4cc1c9937e413fa9c733f00726b6e92025-08-20T03:41:39ZengBMCBMC Health Services Research1472-69632025-03-0125111110.1186/s12913-025-12455-9Costs of delivering COVID-19 vaccine in Botswana during the height of the pandemic: a retrospective studyKelsey Vaughan0Onalenna T. Mokena1Goabaone Rankgoane-Pono2Moses Keetile3Ulla Kou Griffiths4Bang for Buck ConsultingDepartment of Health Policy, Research and Development, Ministry of HealthUniversity of BotswanaDepartment of Health Policy, Research and Development, Ministry of HealthUNICEF, Health ProgrammeAbstract Background The development, distribution and delivery of COVID-19 vaccines following the outbreak of the global coronavirus pandemic in February 2020 is the largest global immunization action in history. To assist with planning and resource mobilization efforts, a global-level model was used to estimate expected COVID-19 vaccine delivery costs employing data from the literature on childhood and adult flu vaccine delivery. However, country-level studies were needed to validate these estimates, learn lessons for future pandemics, and plan for forthcoming COVID-19 vaccination of priority groups. Methods We tested several methodological innovations to estimate total costs and costs per dose of COVID-19 vaccine delivery in Botswana. Costs incurred by all government sectors, parastatals, donors, and non-governmental organizations were included. Both fiscal costs (financial outlays) and the value of selected, existing human resources and donated vaccines (economic costs) were included. Results Fiscal delivery costs of COVID-19 vaccination were estimated at US$49.8 million for a 13-month period, with over half accounting for newly hired human resources. Newly hired staff supported not just vaccine delivery, but also co-ordination and social mobilization efforts. The value of existing human resources deployed to support COVID-19 vaccination was US$36.6 million. Based on 2.6 million doses delivered, the fiscal and economic delivery cost per dose was US$19 and US$33, respectively. Vaccines were procured and donated at an average price per dose of US$13.46, increasing the economic cost per dose delivered to approximately US$47. Conclusions In Botswana, costs were substantially higher than modelled estimates for COVID-19 vaccine delivery and the costs of delivering routine childhood vaccines. This suggests that rolling out a new vaccine to an entire population in the middle of a pandemic requires additional financial investments beyond what has been typical for immunization services in the past.https://doi.org/10.1186/s12913-025-12455-9COVID-19 vaccinationVaccineImmunizationDelivery costsImmunization economicsCosting
spellingShingle Kelsey Vaughan
Onalenna T. Mokena
Goabaone Rankgoane-Pono
Moses Keetile
Ulla Kou Griffiths
Costs of delivering COVID-19 vaccine in Botswana during the height of the pandemic: a retrospective study
BMC Health Services Research
COVID-19 vaccination
Vaccine
Immunization
Delivery costs
Immunization economics
Costing
title Costs of delivering COVID-19 vaccine in Botswana during the height of the pandemic: a retrospective study
title_full Costs of delivering COVID-19 vaccine in Botswana during the height of the pandemic: a retrospective study
title_fullStr Costs of delivering COVID-19 vaccine in Botswana during the height of the pandemic: a retrospective study
title_full_unstemmed Costs of delivering COVID-19 vaccine in Botswana during the height of the pandemic: a retrospective study
title_short Costs of delivering COVID-19 vaccine in Botswana during the height of the pandemic: a retrospective study
title_sort costs of delivering covid 19 vaccine in botswana during the height of the pandemic a retrospective study
topic COVID-19 vaccination
Vaccine
Immunization
Delivery costs
Immunization economics
Costing
url https://doi.org/10.1186/s12913-025-12455-9
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