THE PROBLEM

Ethiopia, like many other countries, is facing growing pressure to balance ambitious immunization goals with limited funding. As the Ministry of Health develops a new National Immunization Strategy (NIS) for 2026–2030, Ethiopia is faced with difficult decisions about how to use available resources to save the most lives through immunization.

The cost of Ethiopia’s vaccine program is rising rapidly. The proposed portfolio for the next five years is projected to cost nearly twice as much as in the previous five-year period. Yet financing is constrained due to reductions in donor financing and competing priorities for domestic health funding. Following a 25% shortfall in Gavi’s replenishment cycle, Ethiopia’s vaccine support budget from Gavi is lower than in the previous funding period.

This creates a major policy challenge for Ethiopian leadership. How can it maximize health impact with limited funding for vaccines? Which vaccines and program strategies provide the greatest impact for the resources available? How much will Ethiopia be expected to pay for the immunization program under Gavi 6.0, and what options exist to sustainably mobilize additional domestic funding?

THE PHAROS SOLUTION

With support from the Gates Foundation, Pharos is helping Ethiopia’s MOH and partners, including the International Institute for Primary Health Care–Ethiopia (IPHC-E), to answer these questions through integrated analysis of vaccine impact, program costs, co-financing obligations, and financing sustainability under Gavi 6.0. Building on lessons learned from similar work supporting Nigeria, Pharos has developed a country-led analytical platform designed to generate results and strengthen local ownership of the analysis and decision-making process. The work integrates four core pillars:

• Costing and Co-financing: Estimating future vaccine procurement and operational costs under different immunization program scenarios, including Ethiopia’s projected co-financing obligations under evolving Gavi 6.0 policies.
• Fiscal Space: Assessing domestic public financing requirements for vaccines as a share of total government health expenditure.
• Domestic Resource Mobilization: Evaluating financing options to strengthen sustainability and mitigate risks to vaccine delivery as donor support declines.
• Prioritization and Optimization: Supporting evidence-based prioritization and optimization of vaccines (VPOP) based on health impact, cost-effectiveness, and affordability. This includes evaluating new vaccine introductions, product switches, schedule changes, and other strategies.

RESULTS TO DATE (MAY 2026)

Pharos’ ongoing support to Ethiopia has included:

• Assisting Ethiopia in its dialogue and negotiations with Gavi regarding the country’s vaccine budget allocation and co-financing expectations for 2026-2030.
• Developing a user-friendly decision-support tool to analyze the cost and health impact of different immunization program scenarios to support prioritization and optimization of the vaccine portfolio.
• Conducting trainings for the Ministry of Health and the International Institute for Primary Health Care–Ethiopia to transfer tools for integrating costing, co-financing, fiscal space, and prioritization analyses into immunization planning.
• Analyzing Ethiopia’s macroeconomic and health financing landscape to estimate available donor and domestic funding for vaccines and the financing gap under the proposed immunization program.

LOOKING AHEAD

In the coming months, Pharos will continue supporting Ethiopia’s Ministry of Health as it finalizes the National Immunization Strategy and develops its application to Gavi.

Future work will focus on refining financial and prioritization analyses, evaluating alternative vaccine portfolio scenarios, and continuing knowledge transfer to Ethiopia’s immunization and financing teams. Additional workshops with the Ministry of Health and IPHCE will support local capacity for sustainable immunization planning, vaccine financing analysis, and evidence-based decision-making.

Status: Ongoing

Team Members Involved: Mariam Mubarak-Gabrian, Alyssa Agarwal, Robert Hecht, Pablo Gottret.