Cost-effectiveness of Sub-national Geographically Targeted Vaccination Programs: A Systematic Review


Understanding the cost-effectiveness of different geographically targeted sub-national vaccination programs.


This review can inform researchers and policy makers of the current evidence that exists in peer-reviewed literature regarding geographic targeting of vaccination programs as well as their associated costs and health benefits.


Immunisation is an essential component of national health plans. However, the growing number of new vaccine introductions, vaccination campaigns, and increasing administrative costs create logistic and financial challenges, especially in resource-limited settings. Sub-national geographic targeting of vaccination programs is a potential strategy for governments to reduce the impact of infectious disease outbreaks while optimizing resource allocation and reducing costs, promoting sustainability of critically important national immunisation plans. This systematic review explores evidence on the cost-effectiveness of geographically targeted sub-national vaccination programs, either through routine immunisation or supplementary immunisation activities.

Key Messages

  • All studies found geographic targeting of vaccination programs in areas of high disease burden to be cost-effective, and most studies (14/16) found geographic targeting of vaccination to be more cost-effective than a non-targeted strategy.
  • All studies demonstrated heterogenous burden of disease and resource constraints as justification for geographically targeted vaccination.
  • Modelling studies used to estimate health and economic benefits of geographically targeted vaccination suffer from limited comparability across models.
  • Nationwide vaccination was more cost-effective than geographically targeted vaccination in models with longer timeframes that considered herd immunity and estimated economic costs from a societal perspective.
  • Future studies on vaccination introduction would benefit from modelling different vaccine delivery strategies – including routine immunization and campaign strategies, to estimate scenarios that maximize health impact and cost-effectiveness.

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