Peer-reviewed article
Recovery of Routine Immunisation: Mapping External Financing Opportunities for Reaching Zero-Dose Children
Sarah Tougher, Nikhil Mandalia, Ulla Kou Griffiths ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001The COVID-19 pandemic caused significant drops in childhood vaccination coverage, creating millions of zero-dose children (children who have received no vaccines). This study examined how external financing for immunisation and primary healthcare is distributed across 20 countries with the highest numbers of zero-dose children. The researchers found that access to external funding is unequal: some countries can only obtain loans, while others lack allocations from major vaccine funding organisations despite being eligible.
Key points
- COVID-19 led to substantial increases in the number of zero-dose children globally
- Upper-middle-income countries like Brazil and Mexico only have access to loans from the International Bank for Reconstruction and Development, not grants
- Angola, Indonesia, Philippines, and Vietnam lack allocations from Gavi for health systems strengthening or equity acceleration funding, though they are eligible
- Countries have disparate access to external financing for immunisation recovery
- Data quality and comparability across different financing mechanisms is limited
Limitations
This document maps existing financing rather than evaluating the effectiveness of any intervention to recover vaccination coverage. It cannot tell us whether the identified financing gaps are actually being filled or what impact financing arrangements have on immunisation recovery and zero-dose child outcomes.
Abstract
The COVID-19 pandemic has precipitated large declines in childhood vaccination coverage and, consequently, substantial increases in the number of zero-dose children. To effectively respond to these declines, it is necessary to direct resources for recovery. We mapped active external financing for immunisation and primary healthcare in 20 countries with the highest numbers of zero-dose children to promote transparency and donor coordination. We found that countries have disparate access to external financing, with the two upper-middle-income countries (Brazil and Mexico) only having access to loans from the International Bank for Reconstruction and Development. Domestic resource mobilization is, therefore, key in these two countries, although fiscal space is likely constrained. Four additional countries (Angola, Indonesia, Philippines, and Vietnam) do not have allocations from Gavi, the Vaccine Alliance for Health Systems Strengthening, or Equity Accelerator Funding, but are eligible for support under Gavi's Middle-Income Countries Approach. Our methods, which focus on current donor financing, are novel and reveal substantial variations in access to external financing to support immunisation in high-burden countries. The available data differ considerably across financing mechanisms, making it difficult to synthesise the results across funding sources.