Vaccine financing in Nigeria: are we making progress towards self-financing/sustenance?

摘要

Nigeria has an estimated population of 186 million with 23% of eligible children aged 12-23 months fully immunized. Government spending on routine immunization per surviving infant has declined since 2006 meaning the immunization budget needs to improve. By 2020, Nigeria will be ineligible for additional Global Alliance for Vaccination and Immunization (Gavi) grants and will be facing an annual vaccine bill of around US$426.3m. There are several potential revenue sources that could be utilized to fill the potential funding gap, these are however subject to timely legislation and appropriation of funds by the legislative body. Innovative funding sources that should be considered include tiered levies on tele-communications, airline, hotel, alcohol, tobacco, sugar beverage taxes, lottery sales, crowd-sourcing, optimized federal state co-financing etc. To demonstrate monthly income that will be derived from a single tax revenue source, we modelled using Monte Carlo simulation trials the Communication Service Tax that is being introduced by the National Assembly. We used number of active telephone subscribers, penetration ratio, monthly charges, and percent of immunization levy as model scenario inputs and dollars generated monthly as output. The simulation generated a modest mean (SD) monthly amount of $3,649,289.38 ($1,789,651); 88% certainty range $1,282,719.90 to $7,450,906.26. The entire range for the simulation was $528,903.26 to $7,966,287.26 with a standard error of mean of $17,896.52. Sensitivity analysis revealed that percentage of immunization levy contributed 97.9 percent of the variance in the model, number of active subscribers and charges per month contributed 1.5%, and 0.6% respectively. Our modest simulation analysis demonstrated the potential to raise revenue from one possible tax source; when combined, the revenue sources will potentially surpass Nigeria’s long-term financing needs. The ROI of vaccine should supersede all other considerations and prompt urgent activities to cover the impending finance coverage gap.