# Maternal vaccine delivery costs in South Asian settings: estimates from Bangladesh and Nepal

## TL;DR

This study estimates the costs of delivering maternal vaccines in Bangladesh and Nepal to help countries decide if they can afford these programs.

## Contribution

The study provides new cost estimates for maternal vaccine delivery in low- and middle-income countries using stakeholder input and primary data.

## Key findings

- Using existing maternal tetanus vaccine systems is the most feasible strategy for maternal immunization in Bangladesh and Nepal.
- Non-vaccine delivery costs per dose are $0.45–$1.81 (financial) and $2.01–$4.49 (economic) in Bangladesh and Nepal.
- Training health workers and demand generation are major cost drivers in both countries.

## Abstract

Several maternal vaccines are in clinical development. Maternal respiratory syncytial virus (RSV) vaccine has been introduced in several high and upper middle-income countries. With the recent World Health Organization (WHO) RSV prevention recommendation and Gavi, the Vaccine Alliance’s commitment to open a funding window for RSV maternal vaccine programs, the vaccine will soon be available for low- and middle-income markets. Understanding costs of implementing new maternal vaccines within existing health systems in low-and middle-income countries (LMICs) is critical to inform introduction decisions. This study projects the cost of maternal immunization (MI) introduction and delivery in Bangladesh and Nepal.

Using an activity based prospective costing approach, we project MI introduction and delivery costs for a five-year period in each country. In-country stakeholders informed the future MI delivery strategies used for costing. Interviews with immunization and maternal health program representatives informed activities and resource needs. Primary data from a sample of sub-national health administrative units including vaccine stores and health facilities also informed anticipated MI operational costs. Financial and economic costs to the health system are estimated and reported in 2023 US$ units.

Stakeholders confirmed utilizing existing maternal tetanus vaccine delivery systems as the most feasible strategy for future MI delivery in both countries. The non-vaccine cost of delivering one dose of maternal vaccine was estimated at $0.45 and $1.81 (financial) and $2.01 and $4.49 (economic) in Bangladesh and Nepal, respectively. Excluding commodity cost, health worker training and demand generation activities were among the largest cost drivers in both countries. Relatively lower unit costs in Bangladesh are partly due to larger target population size leading to some efficiency in introduction costs. The anticipated coverage and baseline health system capacity gaps also contribute to the variation in unit costs between countries.

MI delivery costs in LMICs are little known and this study contributes to filling this gap. These cost projections can equip countries to make informed introduction decisions as they evaluate the affordability and sustainability of MI programs in respective countries.

The online version contains supplementary material available at 10.1186/s12889-025-25786-3.