{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T18:18:38Z","timestamp":1792088318813,"version":"4.4.0"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-004105 and INV-039881"],"award-info":[{"award-number":["INV-004105 and INV-039881"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>While COVID-19 vaccines were crucial in containing the pandemic, there is limited evidence on the cost of delivering them in low- and middle-income countries. We estimated the cost of delivering COVID-19 vaccines in Bangladesh, C\u00f4te d\u2019Ivoire, the Democratic Republic of the Congo, Mozambique, the Philippines, Uganda, and Vietnam.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively estimated the financial and economic cost of COVID-19 vaccine delivery from a payer perspective, using a bottom-up approach. Cost data were collected from 290 sites, while qualitative interviews were conducted with 192 key informants. We estimated volume-weighted average costs per dose in 2022 USD, for introduction phases, delivery modalities, and strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The financial cost per dose ranged from $0\u00b729-$2\u00b718 across countries, driven by per diem and supplies. The economic cost per dose ranged from $1\u00b714-$9\u00b750, driven by the cost of labor. Newly hired health workers were a cost driver only in the Philippines. The economic delivery cost per dose was inversely correlated with daily vaccine volume delivered at vaccination sites. Similarly, delivering through campaigns came at a lower unit cost than continuous delivery, and when programs scaled up, the cost per dose decreased dramatically. Political prioritization, health workers\u2019 commitment, and volunteers were highlighted as success factors, while resource constraints at implementation level and health workers shortages were flagged as key challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings demonstrate how under-resourced health systems managed to deliver massive amounts of vaccines with relatively few resources. However, they also expose significant gaps and inefficiencies, and underscores the need to invest in resilient health systems to improve future pandemic responses.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0341964","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T18:30:17Z","timestamp":1770057017000},"page":"e0341964","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["The cost and cost drivers of delivering COVID-19 vaccines in low- and middle-income countries: a bottom-up costing study of rollouts in seven countries"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3326-8008","authenticated-orcid":true,"given":"Flavia","family":"Moi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V\u0103n Minh","family":"Nguy\u1ec5n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Archer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8184-1607","authenticated-orcid":true,"given":"Toz\u00e9","family":"Namalela","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Banks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarek","family":"Hossain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afroja","family":"Yesmin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5289-673X","authenticated-orcid":true,"given":"Cathbert","family":"Tumusiime","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Muheki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelsey","family":"Vaughan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elise","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael Deo","family":"Estanislao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre Z.","family":"Akilimali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong Thi","family":"Duong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chien Chinh","family":"Vien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Am\u00e9lia","family":"Dipuve","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro Marizane","family":"Pota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monjurul","family":"Islam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Kiggundu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Okello Ayen","family":"Daniel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah De Los","family":"Reyes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremie","family":"de Guzman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1250-7015","authenticated-orcid":true,"given":"Christelle","family":"Cuevas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Primrose","family":"Nakazibwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl","family":"Schutte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minh Van","family":"Hoang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8617-6706","authenticated-orcid":true,"given":"Laura","family":"Boonstoppel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"issue":"4","key":"pone.0341964.ref001","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1038\/s41577-021-00522-1","article-title":"The first 12 months of COVID-19: a timeline of immunological insights","volume":"21","author":"T Carvalho","year":"2021","journal-title":"Nat Rev Immunol"},{"key":"pone.0341964.ref002","unstructured":"World Health Organization. WHO Director-General\u2019s statement on the advice of the IHR emergency committee on novel coronavirus. 2020."},{"key":"pone.0341964.ref003","unstructured":"World Health Organization. WHO Director-General\u2019s opening remarks at the media briefing \u2013 5 May 2023. https:\/\/www.who.int. 2023."},{"key":"pone.0341964.ref004","unstructured":"World Health Organization. WHO COVID-19 Dashboard. 2021."},{"key":"pone.0341964.ref005","unstructured":"World Health Organization. COVID-19 continues to disrupt essential health services in 90% of countries. 2021."},{"issue":"7","key":"pone.0341964.ref006","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1038\/s41562-021-01122-8","article-title":"A global database of COVID-19 vaccinations","volume":"5","author":"E Mathieu","year":"2021","journal-title":"Nat Hum Behav"},{"key":"pone.0341964.ref007","unstructured":"Gavi TVA. Gavi and global health actors collaborate to accelerate COVID-19 technologies for all. 2020."},{"issue":"8","key":"pone.0341964.ref008","doi-asserted-by":"crossref","DOI":"10.1016\/S1473-3099(23)00279-7","article-title":"Leveraging lessons from the COVID-19 pandemic to strengthen low-income and middle-income country preparedness for future global health threats","volume":"23","author":"A Alakija","year":"2023","journal-title":"Lancet Infect Dis"},{"issue":"8004","key":"pone.0341964.ref009","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1038\/s41586-024-07158-w","article-title":"Last-mile delivery increases vaccine uptake in Sierra Leone","volume":"627","author":"NF Meriggi","year":"2024","journal-title":"Nature"},{"issue":"1","key":"pone.0341964.ref010","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1186\/s12913-024-11251-1","article-title":"Costs of the COVID-19 vaccination programme: estimates from the West Rand district of South Africa, 2021\/2022","volume":"24","author":"I Edoka","year":"2024","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pone.0341964.ref011","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1186\/s12913-025-12455-9","article-title":"Costs of delivering COVID-19 vaccine in Botswana during the height of the pandemic: a retrospective study","volume":"25","author":"K Vaughan","year":"2025","journal-title":"BMC Health Serv Res"},{"key":"pone.0341964.ref012","article-title":"Costs and predicted financing gap to deliver COVID-19 vaccines in 133 low- and middle-income countries","author":"U Griffiths","year":"2022"},{"issue":"1","key":"pone.0341964.ref013","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1186\/s12913-022-07864-z","article-title":"Examining the unit costs of COVID-19 vaccine delivery in Kenya","volume":"22","author":"S Orangi","year":"2022","journal-title":"BMC Health Serv Res"},{"issue":"9","key":"pone.0341964.ref014","doi-asserted-by":"crossref","first-page":"674","DOI":"10.2471\/BLT.23.291105","article-title":"COVID-19 vaccination campaigns in fragile and conflict-affected settings, Somalia","volume":"102","author":"M Farid","year":"2024","journal-title":"Bull World Health Organ"},{"issue":"1","key":"pone.0341964.ref015","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1186\/s12916-023-02944-1","article-title":"Estimating the delivery costs of COVID-19 vaccination using the COVID-19 Vaccine Introduction and deployment Costing (CVIC) tool: the Lao People\u2019s Democratic Republic experience","volume":"21","author":"KHT Yeung","year":"2023","journal-title":"BMC Med"},{"issue":"3","key":"pone.0341964.ref016","article-title":"What, how and who: Cost-effectiveness analyses of COVID-19 vaccination to inform key policies in Nigeria","volume":"3","author":"FJ Ruiz","year":"2023","journal-title":"PLOS Glob Public Health"},{"issue":"12","key":"pone.0341964.ref017","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1016\/j.vaccine.2022.01.036","article-title":"Estimating the cost of COVID-19 vaccine deployment and introduction in Ghana using the CVIC tool","volume":"40","author":"J Nonvignon","year":"2022","journal-title":"Vaccine"},{"key":"pone.0341964.ref018","article-title":"General study protocol: COVID-19 vaccine delivery costing","year":"2021"},{"issue":"1","key":"pone.0341964.ref019","doi-asserted-by":"crossref","first-page":"2411820","DOI":"10.1080\/21645515.2024.2411820","article-title":"The cost of COVID-19 vaccine delivery in Bangladesh","volume":"20","author":"A Yesmin","year":"2024","journal-title":"Hum Vaccin Immunother"},{"key":"pone.0341964.ref020","article-title":"How to Conduct an Immunization Campaign Costing Study: Methodological Guidance","author":"L Boonstoppel","year":"2021"},{"key":"pone.0341964.ref021","volume-title":"Filipino nurses in the era of COVID-19","author":"C Muir","year":"2020"},{"key":"pone.0341964.ref022","article-title":"The immunization delivery cost catalogue (IDCC)","year":"2024"},{"issue":"1","key":"pone.0341964.ref023","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1186\/s12913-024-11645-1","article-title":"Cost of COVID-19 vaccine delivery in nine States in Nigeria via the U.S. Government Initiative for Global Vaccine Access","volume":"24","author":"DH Noh","year":"2024","journal-title":"BMC Health Serv Res"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0341964","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T18:30:22Z","timestamp":1770057022000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0341964"}},"subtitle":[],"editor":[{"given":"Susan","family":"Horton","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,2]]},"references-count":23,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0341964","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,2]]}}}