Immunization Financing in MENA Middle-Income Countries

This report examines health financing and, within that, immunization financing and vaccine procurement in the Middle East and North Africa (MENA) region, which consists of 14 middle-income countries (MICs) and six highincome countries. The report focuses on the MICs, given that their lower levels of health expenditure pose more challenges for financing immunization. Of the 14 MICs, Djibouti, the Sudan and Yemen have been eligible for Gavi assistance since 2000. Gavi is a source of support for the introduction of new and underused vaccines, operational costs of campaigns, cold chains, and health system strengthening. The three countries eligible for Gavi support have introduced pentavalent, pneumococcal conjugate and rotavirus vaccines, and procure vaccines through the UNICEF Supply Division (UNICEF SD) at favourable prices for Gavi countries. The MICs not supported by Gavi face challenges in introducing new vaccines due to competing priorities, highly constrained resources, the higher cost of new vaccines, information gaps, and procurement rules and procedures. In many cases, they lag behind countries eligible for Gavi support on new introductions. Conflicts, instability and the prevailing geopolitical situation in the region have hit immunization programmes hard in several countries, including Iraq, Libya, the Syrian Arab Republic and Yemen. For example, World Health Organization/UNICEF estimates of coverage of the third dose of the diphtheria-tetanus-pertussis vaccine (DTP3) in the Syrian Arab Republic fell from 80 per cent in 2010 to 42 per cent in 2016. Conflicts and instability have spilled over into other countries. Refugees make up about 1 in 6 people in Lebanon, and 1 in 11 in Jordan. Large refugee populations are also found in Algeria, Egypt, Iraq and the Sudan. These Governments are stretched to provide health (and immunization) services to these populations and adapt delivery strategies to reach displaced persons. Nomads, recent urban migrants, certain ethnic groups and people living in more remote geographic areas, in addition to refugees, have less access to immunization services.