Abstract
INTRODUCTION: The maternal vaccine landscape is expanding, including the anticipated global rollout of the now approved respiratory syncytial virus maternal vaccine. Integrating maternal immunization (MI) into health systems in low-and middle-income countries (LMICs) will require adaptation to existing immunization delivery platforms and have cost implications. In this study, we project the cost of maternal vaccine introduction and delivery in Ghana and Mozambique to help inform introduction decisions and ensure financial sustainability of future MI interventions. METHODS: We used an activity-based prospective cost projection approach to estimate MI introduction and delivery costs for a five-year period from a health system perspective. Country stakeholders informed the strategies for MI delivery. Interviews with key immunization and maternal health program representatives informed on the anticipated health system adaptation requirements, activities, and resource needs taken into account in the cost projections. Supplementary data from a sample of sub-national health administrative units, vaccine stores, and health facilities also informed the costing analysis. Financial and economic costs are estimated and presented in 2023 USD units. RESULTS: New maternal vaccines in both countries are anticipated to be delivered leveraging the existing maternal tetanus vaccine delivery practices. The non-vaccine cost of delivering one dose of maternal vaccine was estimated at $3.42 (financial) and $4.12 (economic) in Ghana, and $1.84 (financial) and $2.21 (economic) in Mozambique. Health worker training, communication and social mobilization, and program planning and coordination constitute the main cost drivers. Cost differences between countries are partly driven by the anticipated baseline coverage and baseline health system capacity gaps. DISCUSSION: Very few studies exist on the costs of delivering maternal vaccine in LMICs. This study begins to fill this gap. These MI cost projections are comparable to other new vaccine introduction costs in similar settings, providing insights for local and global stakeholders seeking to understand costs of MI delivery.