美国华盛顿大学Angela E Micah团队研究了2000-2017年低收入和中等收入国家按资金来源，估算常规和补充免疫接种活动的总支出。相关论文发表在2021年11月4日出版的《柳叶刀》杂志上。

儿童免疫接种是最具成本效益的卫生干预措施之一。然而，尽管其价值已为人所知，但全球均可获得疫苗的愿景仍远未实现。虽然供应方面的限制导致许多卫生系统的疫苗覆盖率不足，但对免疫接种资金尚未进行全面分析。研究组的目标是通过按资金来源和活动类型分类生成免疫接种资金估计数来填补这一空白，以突出免疫接种的资金状况并为政策制定提供信息。

在这项金融建模研究中，研究组估计了2000至2017年135个中低收入国家（由世界银行确定）的年度免疫支出，重点是政府、捐赠者和现金支出，及疫苗和交付成本的分类支出，以及例行时间表和补充活动。为了准确评估，研究组从国民健康账户、世卫组织-联合国儿童基金会联合报告表、综合多年计划、免疫联盟、疫苗联盟和卫生计量与评估研究所2019年发展援助卫生数据库中提取数据。通过汇总政府、捐赠者、预付的私人和家庭支出估计来估算免疫接种总支出。

2000-2017年间，免疫接种资金总额为1124亿美元。在所有中低收入国家中，政府支出始终是最大的资金来源，每年占总免疫支出的60.0%到79.3%不等。在各收入群体中，低收入和中低收入国家和地区平均每名存活婴儿的免疫接种支出相似，2017年，低收入国家和中低收入国家的平均支出分别为40美元和42美元。

在低收入国家和地区，发展援助占2017年免疫接种总支出的最大份额（69.4%，6.32亿美元）。在135个国家中，研究组观察到随着时间的推移，疫苗覆盖率提高，政府在免疫接种方面的支出增加，尽管在一些国家（主要是拉丁美洲和加勒比以及撒哈拉以南非洲），疫苗覆盖率随着时间的推移而下降，而支出却在增加。

这些估计突出了过去二十年在增加免疫接种支出方面取得的进展，但仍存在诸多挑战。

附：英文原文

Title: Estimating total spending by source of funding on routine and supplementary immunisation activities in low-income and middle-income countries, 2000–17: a financial modelling study

Author: Gloria Ikilezi, Angela E Micah, Steven D Bachmeier, Ian E Cogswell, Emilie R Maddison, Hayley N Stutzman, Golsum Tsakalos, Logan Brenzel, Joseph L Dieleman

Issue&Volume: 2021-11-04

Abstract:

Background

Childhood immunisation is one of the most cost-effective health interventions. However, despite its known value, global access to vaccines remains far from complete. Although supply-side constraints lead to inadequate vaccine coverage in many health systems, there is no comprehensive analysis of the funding for immunisation. We aimed to fill this gap by generating estimates of funding for immunisation disaggregated by the source of funding and the type of activities in order to highlight the funding landscape for immunisation and inform policy making.

Methods

For this financial modelling study, we estimated annual spending on immunisations for 135 low-income and middle-income countries (as determined by the World Bank) from 2000 to 2017, with a focus on government, donor, and out-of-pocket spending, and disaggregated spending for vaccines and delivery costs, and routine schedules and supplementary campaigns. To generate these estimates, we extracted data from National Health Accounts, the WHO–UNICEF Joint Reporting Forms, comprehensive multi-year plans, databases from Gavi, the Vaccine Alliance, and the Institute for Health Metrics and Evaluation's 2019 development assistance for health database. We estimated total spending on immunisation by aggregating the government, donor, prepaid private, and household spending estimates.

Findings

Between 2000 and 2017, funding for immunisation totalled US$112·4 billion (95% uncertainty interval 108·5–118·5). Aggregated across all low-income and middle-income countries, government spending consistently remained the largest source of funding, providing between 60·0% (57·7–61·9) and 79·3% (73·8–81·4) of total immunisation spending each year (corresponding to between $2·5 billion [2·3–2·8] and $6·4 billion [6·0–7·0] each year). Across income groups, immunisation spending per surviving infant was similar in low-income and lower-middle-income countries and territories, with average spending of $40 (38–42) in low-income countries and $42 (39–46) in lower-middle-income countries, in 2017. In low-income countries and territories, development assistance made up the largest share of total immunisation spending (69·4% [64·6–72·0]; $630·2 million) in 2017. Across the 135 countries, we observed higher vaccine coverage and increased government spending on immunisation over time, although in some countries, predominantly in Latin America and the Caribbean and in sub-Saharan Africa, vaccine coverage decreased over time, while spending increased.

Interpretation

These estimates highlight the progress over the past two decades in increasing spending on immunisation. However, many challenges still remain and will require dedication and commitment to ensure that the progress made in the previous decade is sustained and advanced in the next decade for the Immunization Agenda 2030.

DOI: 10.1016/S0140-6736(21)01591-9

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01591-9/fulltext