Ikilezi G, Micah AE, Bachmeier SD, et al. - Despite the known value of childhood immunization, global access to vaccines remains far from complete. As many health systems have supply-side constraints that result in inadequate vaccine coverage, researchers sought to make a comprehensive analysis of the funding for immunization by generating estimates of funding for immunization disaggregated by the source of funding and the type of activities.

• This financial modelling study involved estimation of annual spending on immunizations for 135 low-income and middle-income countries (as determined by the World Bank).

• From 2000 to 2017, total funding for immunization was estimated at US$112.4 billion.

• Aggregated across all low-income and middle-income countries, the largest source of funding consistently remained government spending, which contributed between 60.0% and 79.3% of total immunization spending each year (corresponding to between $2.5 billion [2.3–2.8] and $6.4 billion [6.0–7.0] each year).

• Across income groups, similar immunization spending was recorded per surviving infant in low-income and lower-middle-income countries and territories, with average spending of $40 (38–42) in low-income countries and $42 (39–46) in lower-middle-income countries, in 2017.

• In low-income countries and territories, the largest share of total immunization spending in 2017 (69.4% [64.6–72.0]; $630.2 million) was provided by the development assistance.

• Although in some countries, higher vaccine coverage and increased government spending on immunization are recorded over time; this is predominantly evident in Latin America and the Caribbean.

• In sub-Saharan Africa, a decrease in vaccine coverage occurred over time, while there was an increase in spending.

• Overall findings suggest that despite the increasing spending on immunization, many challenges still remain and will necessitate dedication and commitment to ensure sustainment of the progress made in the previous decade and advancement in the next decade for the Immunization Agenda 2030.