THE PROBLEM

In late 2023, the incoming Nigeria health minister was given estimates of the medium term cost of childhood vaccines against a wide range of diseases.  While these vaccines would save hundreds of thousands of lives, their projected cost was a hefty $1.6 billion for three years. The Nigerian government was also expected to cover a growing share of these vaccine costs—well over half each year, as the multilateral funder, Gavi, gradually withdrew by 2028.

Were these numbers accurately estimated, the Minister wanted to know?  Were there ways to save money by tightening the choice of vaccines or substitute less costly products for more expensive ones?  Beyond this, could Nigeria afford to pay its share, given limited tax collections and allocations of the national budget to the Health Ministry? How might Nigeria mobilize more domestic funding for health and vaccines, given vaccines’ outsized impact on child health and survival? And was there scope for Nigeria to negotiate a new deal with Gavi, to soften the increase in the share of vaccine purchase costs that the government would need to pick up?

To answer these questions, the Minister invited Pharos Global Health to model the expected cost, cost-sharing (the amount to be paid by Gavi, the amount of national “cofinancing”), and options for domestic resource mobilization that might give Nigeria more “fiscal space” to pay for the vaccines. He requested that the Pharos team directly advise him and the head of his National Primary Health Care Development Agency (NPHCDA) on these matters, so they could take timely decisions.

THE PHAROS SOLUTION

Using multiple grants and contracts from Gavi and from the Gates Foundation, Pharos Global has been conducting an in-depth analysis of Nigeria’s vaccine financing outlook, challenges, and possible policy actions. During this time, the work has influenced Gavi’s shifting financing policies and practices and has fed into a number of initiatives by the Ministry of Health to expand sustainable, reliable national funding of vaccines from central and decentralized sources.  The work comprises an interactive set of modeling tools related to:

• Costing and Co-financing: Estimating future vaccine costs and Nigeria’s share under the evolving  Gavi policy frameworks and rules for eligible vaccines and levels of cost-sharing.
• Fiscal Space: Assessing domestic public financing requirements for vaccines as a share of total government health expenditure.
• Domestic Resource Mobilization: Financing options to enhance sustainability and mitigate risks to vaccine delivery, including expanding the basic health ministry budget, tapping other sources such as Gross Federation revenues and the value-added tax pool.

Prioritization and Optimization: Obtaining efficiency gains (more vaccinations for a given budget) via switching to cheaper products and reducing vaccine wastage in the national supply chain and at points of service delivery, while evaluating the impacts and costs of introducing new vaccines.

RESULTS TO DATE

The work on this project has yielded numerous results, including:

• Facilitating decisions by the Nigeria health ministry to slow the rate of introduction of new vaccines for malaria and for multiple strains of meningitis
• Assisting Nigeria in its dialogue and negotiations with Gavi on co-financing, which have led to reclassification of Nigeria as a country that will experience slower transition to financial self-sufficiency, with Gavi continuing to pay a portion of vaccine costs to at least 2030 and probably beyond
• Supporting a process of greater openness and transparency between Gavi and Nigeria, in which both sides can share their data, assumptions, and projections of vaccine cost and financing
• Backing the Healthy Ministry’s proposals to the cabinet, Finance Ministry, and State governors to develop new sources of domestic financing that can be used to pay for vaccines and other essential health commodities

LOOKING AHEAD

Starting in late 2025, Pharos has partnered with Solina, a highly respected national consulting organization, to continue the analytical and advisory work of the past two years. Based on requests from the health minister and executive director of NPHCDA, the Pharos-Solina team is being asked to monitor and interpret the radically new Gavi policies on immunization financing that are being rolled out in 2026 and what they mean for Nigeria. Within the new Gavi funding allocations to Nigeria and what the country can afford to do with domestic financing, Pharos has also been requested to rank and prioritize among Nigeria’s vaccines so that decisions on product switches and new vaccine introductions can be based on evidence of health impact and cost-effectiveness. Finally, Pharos-Solina have been enlisted by the government to help it advocate for new streams of domestic funding and help to implement new laws and regulations that will channel more sustainable funds to the purchase of vaccines and other medicines.

The modeling instruments that Pharos has created for the Nigeria work are now being combined in a single integrated tool for use in Nigeria and other countries facing similar challenges.

Status: Ongoing

Team Members Involved: Mariam Mubarak-Gabrian, Alyssa Agarwal, Robert Hecht, Pablo Gottret, Jewelwayne Cain, and Maria Stavridou.