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 using data from the literature on childhood and adult flu vaccine delivery estimated expected COVID-19 vaccine delivery costs. However, country-level studies were needed to validate these estimates, learn lessons for future pandemics, and plan for future 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 Total, 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 redeployed 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 were 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 cost 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.