# Financial risk protection from vaccines in 52 Gavi-eligible low- and middle-income countries: A modeling study

## TL;DR

This study models how vaccines in 52 low- and middle-income countries can prevent financial hardship by reducing healthcare costs, especially for the poorest populations.

## Contribution

The study quantifies the financial risk protection benefits of vaccines across different socioeconomic groups in Gavi-eligible countries.

## Key findings

- Vaccines could avert ~200 million cases of catastrophic health expenditure from 2000 to 2030.
- About half of the averted cases benefit the poorest quintiles, with measles vaccine showing significant impact.
- The study highlights the dual role of vaccines in improving health and reducing poverty.

## Abstract

Poverty alleviation is a major global development goal. Vaccines have the potential to provide financial risk protection (FRP) by preventing illnesses and associated healthcare costs. We estimate the lifetime FRP benefits generated by major vaccines among individuals vaccinated between 2000 and 2030 in low- and middle-income countries (LMICs).

We developed a microsimulation model to quantify the number of cases of catastrophic health expenditure (CHE) averted by a range of vaccines in 52 Gavi-eligible countries, stratified by wealth quintile. Vaccines protecting against five pathogens were considered, i.e., hepatitis B (routine and birth dose vaccine), Haemophilus influenzae type B, rotavirus, measles (routine and supplementary campaign vaccine), and Streptococcus pneumoniae. Model inputs were obtained from secondary data sources, including infection reduction rates under various immunization coverage scenarios, out-of-pocket health expenditures, transportation costs, wage losses, and healthcare utilization associated with disease treatment and consumption expenditures. CHE cases were defined as exceeding 10% of annual consumption, with sensitivity analyses conducted using thresholds of 25% and 40%, as well as impoverishing health expenditures were estimated. All vaccines, singly and collectively, showed a large impact on FRP and could avert ~200 million CHE cases across 52 Gavi-eligible countries from 2000 to 2030. Importantly, about half of all CHE cases were prevented among the poorest quintiles. When evaluated at a 10% threshold for CHE, the first dose of measles vaccine stood out in averting around 1,400 CHE cases per 10,000 vaccinated individuals in the poorest quintile, that is a total of 44 million CHE cases averted. A key limitation is the assumption of uniform disease risks in the absence of vaccination across quintiles, which may underestimate benefits for poorer groups.

Vaccines can provide substantial FRP benefits, particularly among the most disadvantaged populations. Sustained investments to ensure vulnerable populations receive vaccinations in LMICs can therefore not only improve health outcomes but also contribute to poverty reduction.

Financial risk protection (FRP) is a core element of universal health coverage, yet the FRP benefits of vaccines remain underexplored compared to their well-established health benefits.

Out-of-pocket health expenditures are a major driver of poverty, and preventive strategies like vaccination could protect households, especially the poorest.

More evidence is needed on how vaccines contribute to FRP across different socioeconomic groups in low- and middle-income countries (LMICs).

Used a microsimulation model combining vaccine impact projections with data on wealth, healthcare use, and medical/nonmedical costs across 52 Gavi-eligible countries (2000–2030).

Estimated nearly 200 million cases of catastrophic health expenditure (CHE) averted, with nearly half benefiting the poorest quintiles.

Identified vaccines that yield the greatest returns in deaths and CHE averted per dollar spent, providing guidance for resource allocation.

Vaccines play a dual role: preventing illness and alleviating poverty, particularly among disadvantaged groups in LMICs.

Sustained vaccine investments are essential to achieve health equity and poverty reduction targets, including the Sustainable Development Goals.

A main limitation is the assumption of uniform disease risks in the absence of vaccination across quintiles, which may underestimate benefits for poorer groups.

In this modelling study, Boshen Jiao and colleagues investigate the financial risk protection vaccines can provide by preventing illnesses and associated healthcare costs in 52 low- and middle-income countries.