Policy Brief No.

2—Group 1A

University of the Philippines Open University

International Health and Development - IH201

INVESTMENTS ON IMMUNIZATION:
A Landscape Analysis of Lao PDR’s
Health Expenditures on Vaccination Programs
ABAD, L., ABELARDE, K., ALAWI, N., ALMIRAÑEZ, J., ANDRES, M., & AREJA., M.

INTRODUCTION & Gavi, n. d.). Also, for the 2016 to 2020 period,
the World Bank, in partnership with the
The health of a population is important from a Government of Australia and ADB will provide
public health and economic perspective as additional resources which can be used for
healthy individuals contribute to economic operational costs (World Bank, 2017).
growth. Vaccination has the potential to
contribute substantially to improving population BETTER HEALTH OUTCOMES
health and thereby economic growth. Therefore,
assessment of the value of vaccines and Lao PDR is one of the least-developed countries
vaccination needs to consider not just the direct that undergoes rapid health transition in terms of
impact on health and healthcare but also the demography, epidemiology and health financing.
wider impact on economic growth, which In April 2015, Lao PDR became the first country to Due to this, the country is at the edge of being a
requires a macroeconomic analysis of vaccination run a Gavi-supported Japanese encephalitis (JE) middle-income country by 2030. From 2002 to
programs. (Quilici et al 2015) campaign. This was just 18 months after WHO 2012, a decline in national poverty rate (33.5% to
added a JE vaccine developed by Chengdu 23.2% respectively) was reported resulting from a
Lao People’s Democratic Republic (Lao PDR) has Institute of Biological Products to the list of strong economic growth. With advent
been tagged as one of the fastest growing prequalified vaccines that United Nations stabilization in the economy of Lao PDR, follows a
economies in the East Asia and Pacific region and agencies can procure. Following the success of good health financing accountability that boost
the 13th fastest growing economy globally the catch-up campaign, Lao PDR added JE vaccine the improvement on the implementation of
according to World Bank. In early 2000’s, child to its routine immunization schedule. Due to this, various health program for its people. One of
survival against communicable diseases was 9 million children had been immunized by the these is the Child Immunization Program (World
indeed quite a challenge. According to the end of 2016 (Gavi, n. d.). Bank, 2017).
Millennium Development Goals Report, 2004
Progress Report Lao PDR, “Success [in achieving The most important feature is the remarkable The surge in investment on the routine
MDG4] will be severely hampered by the low increase in expenditure since 2014 compared to immunization program of Lao PDR led to different
coverage of the expanded program on the preceding years, both in terms of total effects and on different aspects.
immunization, children’s poor nutritional status, immunization expenditure and in expenditure
and services that are poor in terms of both access financed domestically. Between 37% and 48% of Decline in Mortality, Changes in Causes of Death
and quality.” During that time, one in ten Lao the total immunization expenditure was financed Between 2000 and 2015, Lao PDR recorded a
children still dies before the age of five. by the Government of Lao PDR (GoL) during 2014 significant decline in infant and under-five
to 2016 (up from an average of around 7% in mortality rates. The infant mortality rate
This report tackles Lao PDR’s expenditures on earlier years). Within the total expenditure, the decreased from 83 in 2000 to 51 in 2015, while
immunization which soared through the years spending on vaccines itself has increased more the child (under-five) mortality rate dropped from
and the after effects to its people. than fourfold between 2013 and 2016, mostly 118 to 67. Substantial progress has been made in
due to the introduction of new vaccines (such as the reduction of vaccine-preventable diseases.
FINANCIAL INVESTEMENTS the Pneumococcal vaccine in June 2014). The The share in the disease burden of, for example,
share of expenditure on vaccines financed
ON IMMUNIZATION domestically also went up, showing an increase
Measles, Tetanus, and Whooping Cough,
decreased from 9.60%, 2.72%, and 0.97% to
The World Health Organization (WHO) financing from under 10% in previous years to 12, 23 and 0.24%, 0.10%, and 0.54%, respectively between
analysis on immunization shows the countries' 24 percent in 2014, 2015, and 2016 respectively. 1990 and 2016. Measles fell from rank 3 in causes
trend on spending for immunization programs. It The immunization program has been largely of death and disability to rank 74; Tetanus from
considers vaccine purchase and delivery. The data dependent on funding from external sources rank 8 to rank 99; and Whooping Cough from
is on government expenditure on routine accounting for 76% of the total spending on rank 18 to rank 34 (World Bank, 2017).
immunization per live birth in the country, immunization in Lao PDR over the period 2010 to
recorded in US dollars ($). The country with the 2014. The largest share of this (22% of total Improvement in Immunization Program
highest increase in immunization spending (both spending between 2010 and 2014 and 29% of Since 2010, Lao PDR's immunization program
in the Western Pacific and globally) from 2010 to external spending) was provided by Gavi, the coverage dramatically improved. Specifically,
2015 is Lao PDR with a massive increase of 1971% Vaccine Alliance. Other development partners proportion of children vaccinated with Diphtheria
(WHO, 2017). include US CDC, UNICEF and WHO (World Bank, -Pertussis-Tetanus increased from 74% in 2012 to
2017). 82% in 2016. In addition, coverage of measles
There was a very huge increase from 1.4% in immunization shows increment from 64% in 2010
2013 to 25% in 2014 in the government to 76% in 2016 (World Bank, 2017).
expenditure for vaccination in Lao PDR (WHO,
2017). Increased spending has largely been made SUSTENANCE OF
possible due to funding from the international IMPROVEMENTS
organization Gavi, the Vaccine Alliance. Gavi, the
Vaccine Alliance supported more than half of Country's spending on Immunization programs
financing for new and underused vaccines in the considerably increased through years. This
country from 2010 to 2014. Gavi is being funded increase in finances has been attributed to the
by governments [Australia, Canada, Denmark, funding from international organizations,
France, Germany, Ireland, Italy, Japan, specifically Gavi, the Vaccine Alliance. Recently,
Luxembourg, Netherlands, Norway, Republic of Lao PDR has entered the termination phase of
Korea, Russia, South Africa, Spain, Sweden, Gavi support. Due to this, the country must
United Kingdom, United States], the European implement interventions to sustain
Commission, the Bill & Melinda Gates improvements in immunization program. Possible
Foundation, as well as private and corporate From 2007 to 2013, the spending on routine recommendations are:
partners (Gavi, n. d.). immunization in Lao PDR increased from less than
$5 million annually to $24.8 million in 2016. The  Ensure sustainable financing to support
The cash support came in in 2013 to 2014 which largest share in the total expenditure on routine Universal Health Coverage.
may have catapulted the government's capacity immunization in 2016 accounted to the cost of  Conduct research to identify effective mix of
to spend for routine immunization. In October the vaccines ($11.4 million, 45%). Expenditure is facility and community-based programs to
2013, Lao PDR became the first South East Asian projected to continue to increase due to the increase service coverage and eliminate
Nation to introduce pneumococcal vaccine and country’s plan to increase coverage and due to inequity.
HPV vaccine, simultaneously tackling two major introduction of new vaccines which includes  Transition from input-based to results-based
killers of children and women respectively – human papillomavirus (HPV), rotavirus, and planning and financing for better health
pneumococcal disease and cervical cancer (ibid). Japanese encephalitis vaccines (World Bank, n. d. outcomes.

REFERENCES: child_survival_lao_pdr05.pdf 8. World Health Organization (WHO). (2017). Analysis of Immunization

1. Gavi. (n. d.) Gavi support for Lao PDR. Retrieved from: https://
www.gavi.org/country/lao-pdr/
2. Gavi. (n. d.) Japanese encephalitis vaccine support. Retrieved from:
https://www.gavi.org/support/nvs/japanese-encephalitis/
3. Quilici, S., Smith, R., & Signorelli, C. (2015). Role of vaccination in
economic growth. Journal of market access & health policy, 3,
10.3402/jmahp.v3.27044. doi:10.3402/jmahp.v3.27044
4. UNICEF. (2005). 2005 Progress Report – Child Survival in Lao PDR.
Retrieved from: https://www.unicef.org/infobycountry/files/
5. World Bank. (n. d.) The World Bank in Lao PDR. Retrieved from:
http://www.worldbank.org/en/country/lao
6. World Bank. (2017). Lao PDR: Health financing system assessment.
Retrieved from https://www.worldbank.org/en/country/lao/
publication/lao-pdr-health-financing-system-assessment
7. World Bank. (2017). Lao PDR: Toward Sustainable Financing for
Immunization Coverage. Retrieved from: http://
documents.worldbank.org/curated/en/680971512154814781/
pdf/121810-REVISED-Policy-Brief-HFSA-11-12-17-v2.pdf
Financing Indicators of the WHO-UNICEF Joint Reporting Form (JRF)
2010-2015. Retrieved from: http://www.who.int/immunization/
programmes_systems/financing/data_indicators/
JRF_Analysis_2010_2015.pdf
University of the Philippines open University
International Health and Development (IH201)
Diploma in International Health
Group 1-A