The cost of funding vaccine outweighs the entire proportion of the capital budget allocated to Primary Health Care in the Ministry of Health budgetary allocation.
For instance while the primary health care budget of Nigeria in 2017, was N24.7bn, the projected cost required for vaccine in that same year was N98bn. GAVI projected to fund vaccine in 2017 with $199m amounting to N60bn, but in the federal government budget, N12.88bn was budget for vaccines; leaving a funding gap of N26bn.
Nigeria has heavily relied on donor funding for vaccines with little contribution coming from the Federal Government. The Global Alliance for Vaccine and Immunization which is the major funder of vaccines in Nigeria first announced its decision to withdraw the funding of vaccine to Nigeria by 2020. It was recently heard that there are plans to extend it by ten years period.
The decision presents a ray of hope for Nigeria however; it is also a window of opportunity for the Nigerian government at all level, to begin to make sustainable plans for the financing of vaccines in Nigeria.
One of the sustainable plans should be local vaccine production; this window period, should provide a long term plan for home grown local vaccine production, including storage and distribution.
The FG and state government should assuming full responsibility to invest in the vaccine value chain. The current cost of vaccines importation is outrageous and not sustainable, it has become a money spinning venture to the international manufacturers of vaccine. It is time to device local solution to cut down this cost.
The minister of health initiated a JVA with May and Baker in 2017, for local vaccine production in Nigeria; beyond the MOU, no known action has been taken.
Certain steps needs to be taken to implement the JVA, if possible; willing investors should be brought into the investment pot to invest in the various components of the vaccine supply chain. More vaccine manufacturing plants needs to be provided, the cold chain, distribution facilities, solar fridge, storage warehouse, renewable energy for power supply etc are examples of components requiring investments.
Also, the federal government’s Medium Term Sector Strategy (MTSS) plans and its annual budget should reflect mid-term strategy for self sustainability in vaccine financing. This will require making appropriate budgetary provisions for budget heads that will help to achieve this. Concentration should be allotted to agencies like the Nigerian Medical Research Council and other medical research institutes in Nigeria to embark on research for the production of vaccines.
The need to fund these agencies for vaccine research and production is timing, giving the fact that Nigeria’s response and preparedness plan to tackle emerging disease outbreaks such as Lassa fever, Ebola Virus, Monkey Pox etc is very poor. The agencies should be able to come up with a blue print and time frame where after such research, they can begin production of vaccines for such outbreaks and including for maternal and child health in Nigeria
In addition, sustainable vaccine financing requires legislation for innovative funding. The Ministry of Health and the National Primary Health Care Development Agency needs to consider having legislation where alternative sources can be provided for the funding of vaccine. Immunization trust fund legislation should be instituted to provide a funding mix for vaccine financing in Nigeria. Sources of fund should consist but not limited to the following; annual budgetary appropriations, funds derived from the Basic Health Care Provision Fund, telecommunication tax, sin tax and voluntary contributions.
States and Local government must also make effort towards vaccine financing by developing funding strategy which will complement the FG’s vaccine sustainability plan. They might be required to set up internal funding mix for vaccine such as a midterm budgetary prioritization plan for vaccines and a vaccine trust fund law that will generate funds to be contributed to the FG’s pool, for the benefit of their states.
In addition to the above, high level collaboration from stakeholders such as the Nigerian Investment Promotion Council, Manufacturers Association of Nigeria with the federal and state government is required to develop an investment road map with profitable incentives for stakeholders in the private sector, willing to invest in the cold chain of vaccine production.
In conclusion, the extension time by GAVI, is not a time for Nigeria to relax on its oars, rather it is a time to plan for the future. Using the indices of population growth and statistics of citizens of reproductive age, it is expected that government meet the demands for vaccines and mainstream this projection into their financial plans for self sustainability in the funding of vaccine before GAVI’s exit.
* Emejuiwe, a Program Officer (Good Governance), with Centre for Social Justice, writes from the Abuja.