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Fifth GAVI Board Meeting, 21-22 June 2001, London, England

June 2001


User Fees and Financing Essential Immunization Services

Beginning in September 2002, countries that have received support from GAVI/The Vaccine Fund will be submitting plans to the GAVI Board indicating how they will assure the long-term financial sustainability of improved immunization programs. These financial sustainability plans are to be signed by the Minister of Finance in each country.

The GAVI Financing Task Force is currently facilitating a process of drawing upon partners and countries to develop financial sustainability guidelines for consideration by the GAVI Board. In the interim, however, there are indications that some countries are proposing immunization user fees as a means to finance the introduction of new vaccines and improved immunization programs as outlined in their applications to GAVI/The Vaccine Fund.

In 2000, the GAVI Financing Task Force undertook a major review of all information and documentation on user fees for immunization and preventive health services. Research findings, multilateral agreements and policies of the World Bank and United Nations agencies all indicate that user fees discourage people from seeking vaccination for themselves and their children and are a disincentive to the utilization of preventive health services, in general.

In addition to the deleterious effect of user fees on people’s decision to use appropriate preventive health services, user fees do not support national and international goals for more effective immunization systems and expanded vaccine coverage. This finding flows from the following:

  • The positive externalities of immunization to the wider community justify public expenditure to promote widespread protection against disease and to stop disease transmission. As such, immunization programs should be a high priority for national government investment.

  • One principal and positive externality – protecting unvaccinated individuals through decreased disease transmission – can only be achieved with high levels of immunization coverage.

  • There is no national or regional data to demonstrate that user fees help achieve high levels of routine immunization coverage.

  • Vaccination is a preventive health intervention, and is more sensitive than curative services to the discouraging effects of user fees.

  • Policies exempting the poor from user fees are difficult to administer.

Given the aforementioned concerns and the importance of conveying an interim message to countries, the Financing Task Force requests the GAVI Board to issue a policy statement to the following effect:

The GAVI Board recognizes that countries are exploring a variety of mechanisms to fund essential and routine immunization services. User fees have been shown to be a disincentive to the utilization of preventive health services including immunization, in particular. The GAVI Board therefore recommends that in the absence of compelling country or regional data unequivocally documenting their value, user fees should not be levied in publicly financed national immunization services.


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