OBJECTIVES

Aligned with global World Health Organization tetanus guidelines, Vietnam is preparing evidence to support a recommendation to introduce Tetanus-Diptheria (Td) vaccine into routine immunization. Toward SDG#3 on supporting the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, the aim of this study was to provide evidence on the costs and budgetary impact of the potential replacement of Tetanus-Toxoid (TT) vaccine with Td vaccine, considering different possible delivery strategies.

METHODS

: Activity-based, ingredients costing estimated the program costs of current (2017) TT vaccination to women of childbearing age (WCBA) and Td campaigns in outbreak areas. Budget impact analysis was performed for the period 2018 to 2025 using cost per dose estimates based on current delivery of these vaccines. We assumed complete cessation of TT vaccination of WCBA and a three-year transition period where Td outbreak control campaigns would still occur. Td vaccine was assumed to be provided to 7-year-old children using either facility-based or school-based delivery, or combined facility- and school-based delivery.

RESULTS

: The delivery cost per dose for current TT vaccination for WCBA was found to be US$1.49 for school-based delivery, US$1.76 for facility-based delivery and US$3.86 for delivery via outreach. Td vaccination through campaigns was estimated to cost US$3.56/dose. During 2018-2025, replacing TT vaccine for WCBA with Td vaccine for 7-year-old children is estimated to save US$6.86 million in immunization delivery costs if a school-based delivery strategy is used, or US$4.18 million if facility-based delivery is used.

CONCLUSIONS

: Delivery of Td routine vaccination via a school-based strategy was the most cost saving compared to the current plan. Study results have already been used to support the pilot delivery of Td vaccination via school-based delivery strategy for 7 year-old children in 30 Northern provinces in late 2019.