The global economic crisis has led to severe austerity measures, with budget cuts impacting all areas of health care, including major cuts to primary health care and a move away from providing universal health coverage. These cuts are disastrous for global health as PHC and UHC are the pillars of effective disease prevention, most importantly for immunization programs against costly vaccine-preventable diseases.
For UHC and PHC to be cost-effective, preventive care is essential. Even with this recognition, many countries still struggle to achieve these goals, at times foregoing investments in primary health care in favor of other priorities. This negatively impacts health services for women, children, and their families.
Immunization as an investment tool
At the core of UHC are goals of equity and access to quality health services for all and protection against financial hardship due to the cost of health services. The goals of immunization efforts parallel those of UHC and are focused on delivering important services and reaching the most vulnerable.
Although immunization doesn’t address all health concerns, an immunization system is crucial to those most at risk of serious illness. These populations can often not access care due to distance from facilities, cost of treatment, and lack of knowledge or trust in the health system. It is also the most vulnerable who are least likely to be able to afford treatment and most likely to experience catastrophic health spending, contributing to multidimensional poverty. Immunization is one of the few interventions that reaches across all wealth quintiles, with considerable — and successful — investments focused on accessing the poorest and hardest-to-reach populations.
The goals of UHC that focus on access and affordability of health care address the relationship between poverty and health. Looking at immunization as one of the most affordable and accessible health services highlights its role in achieving UHC and, more broadly, the equity-focused U.N. Sustainable Development Goals.
In resource-limited settings where care is likely to be delayed, there is a higher risk of serious disease or death. Consequently, the risk of financial hardships due to health care is also increased. A strong immunization and primary care system can help mitigate some of this risk and a number of cost savings could be introduced via programs that deliver vaccines as part of a treatment cluster or in conjunction with new infrastructure such as water management systems.
Governments generally include immunization in their essential health service packages, but fiscal space remains an issue. A study conducted at the International Vaccine Access Center showed a 16-fold return on investment for every dollar spent on vaccines in 73 countries prioritized by Gavi, the Vaccine Alliance. While this represents an impressive return, countries still need to find the revenue to invest in increasingly costly new vaccines, as well as in the delivery costs that go with them.
And in times of emergency, immunization offers an important platform for surveillance and response, showing an ability to maintain the goals of UHC as well as protect people’s health during elevated risk and stressed health systems. The U.N. Refugee Agency reports that an unprecedented 65.6 million people were displaced in 2016 because of complex humanitarian emergencies. Within these populations, the leading causes of morbidity and mortality are vaccine-preventable acute respiratory infections and diarrheal diseases. For example, Yemen is experiencing the worst outbreak of vaccine-preventable cholera in history, compounded by the 14.8 million people the World Health Organization estimates are living without access to PHC. Universal vaccination for cholera and other VPDs — pneumonia, rotavirus, measles, or Hib — are highly recommended during complex humanitarian emergencies, though funding remains low.
Primary goals of WHO recommendations include strengthening immunization, surveillance, and monitoring via investment in PHC systems. This approach has had success during past health-related emergencies, for example, during the 2014 Ebola outbreak. The Nigerian Federal Ministry of Health was able to rapidly contain the outbreak because of the quick activation of an Ebola Incident Management Center to monitor and respond. Despite this and similar success stories for other outbreaks, there is still a paucity of investment in effective monitoring and surveillance programs that can coordinate public health efforts, especially in times of crisis.
Immunization in action
A study looking at pneumonia and diarrhea expenditures in Ethiopia estimated that 11 percent of patients hospitalized for pneumonia or diarrhea experience catastrophic financial consequences. With high potential for financial hardship, the impact of immunization becomes even more critical.
Another study in Ethiopia also showed the benefits of introducing pneumococcal conjugate and rotavirus vaccines along with treatments for pneumonia and diarrhea. These services helped avert a substantial amount of expenditure, particularly in the lowest wealth quintile, illustrating the value of immunization in reducing financial risk and increasing protection and equity.
When considering vaccine investments, it’s important to note their broader impact. In addition to preventing infections, vaccines have been shown to help protect against other diseases and provide relief from the vicious cycle of infectious disease and malnutrition, ultimately playing a role in promoting healthy physical and cognitive growth. Furthermore, these investments have the potential to keep children healthy and increase their ability to perform better and stay in school. This contributes to an increase in productivity and economic growth at both the individual and societal level.
UHC and immunization efforts must move forward together as the success of each depends on the other. Stakeholders from both UHC and immunization programs should therefore collaborate to ensure prevention goals are achieved. With a concerted effort across these domains, program stakeholders can leverage primary health care innovations — such as electronic registries, novel immunization cards, cold chain tracking systems, and digital technologies to create demand — as well as boost education. Investments in immunization must continue to reach those who are most vulnerable.