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

Background 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). Methods and findings 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. Conclusions 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.