OBJECTIVES: To estimate the financial and economic costs of delivering COVID-19 vaccines in one district in the second year of roll out – February 2021 to January 2022, in order to inform future resource planning and budgeting for the National Department of Health.

METHODS: Top-down and ingredient-based costing approaches were adopted to estimate the cost of the COVID-19 vaccination programme from a public payer’s perspective. Cost data for resources utilised at national level and within one South African district (West Rand district) was collected, retrospectively, using standardised questionnaires adapted to the South African setting. Total costs and cost per dose were estimated for facility-based (hospitals and primary healthcare facilities) and school-based delivery channels. To analyse cost drivers, costs were disaggregated according to programme activities and resource types. Qualitative data was also collected to help contextualise cost findings.

RESULTS: Total financial and economic costs, inclusive of vaccine procurement costs, were estimated at approximately US$2.2 million and US$5.5 million, respectively; and cost per vaccine dose estimated at US$17.50 and US$44.15, respectively. Vaccine procurement cost and staff time cost were the largest cost drivers, contributing 65% and 71% to total financial and economic costs, respectively. Total economic costs, inclusive of vaccine procurement costs, was estimated at US$174 000 for hospitals, US$2.5million for primary healthcare (PHC) facilities and US$2.9million for schools . Economic cost per dose was lowest in PHC facilities (US$25.69), followed by hospitals (US$31.60) and highest in schools (US$123.68).

CONCLUSIONS: This study provides cost estimates of integrating the COVID-19 vaccination programme into routine healthcare services. The estimates can be used to inform policy decisions in the public healthcare system. Specifically, our findings suggest that targeted delivery at schools was very labour-intensive and the least cost-efficient when compared to vaccine delivery via hospitals and PHC facilities.