Published in PLOS One on 2026-02-02, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Flavia Moi, Văn Minh Nguyễn, Rachel Archer, Tozé Namalela, Christina Banks, Tarek Hossain, Afroja Yesmin, Cathbert Tumusiime, Charlotte Muheki, Kelsey Vaughan, Elise Smith, Rafael Deo Estanislao, Pierre Z. Akilimali, Hong Thi Duong, Chien Chinh Vien, Amélia Dipuve, Pedro Marizane Pota, Monjurul Islam, Paul Kiggundu, Okello Ayen Daniel, Sarah De Los Reyes, Jeremie de Guzman, Christelle Cuevas, Primrose Nakazibwe, Carl Schutte, Minh Van Hoang, Laura Boonstoppel
Source: PLOS One • DOI 10.1371/journal.pone.0341964
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
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, Côte d’Ivoire, the Democratic Republic of the Congo, Mozambique, the Philippines, Uganda, and Vietnam.
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.
The financial cost per dose ranged from $0·29-$2·18 across countries, driven by per diem and supplies. The economic cost per dose ranged from $1·14-$9·50, 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’ commitment, and volunteers were highlighted as success factors, while resource constraints at implementation level and health workers shortages were flagged as key challenges.
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.
Introduction
The coronavirus disease 2019 (COVID-19) quickly spread across the world and was declared a Public Health Emergency of International Concern by the World Health Organization (WHO) in January 2020 [1,2]. By the time the WHO declared the end of COVID-19’s global health emergency in May 2023, the disease had caused almost 7 million deaths globally, overwhelming health systems and significantly affecting access to and delivery of essential health services [3–5].
Immediately recognized as a crucial tool in containing the disease, COVID-19 vaccines were developed at an unprecedented speed and were introduced less than a year later, in December 2020. Initial supply constraints meant that vaccines had to be rolled out in a phased manner, initially only targeting high-risk individuals. As production ramped up, countries quickly expanded their target population to encompass all adults, with some even including children. A year after they first hit the market, nearly every country in the world had introduced COVID-19 vaccines. By the end of 2021, 9·23 billion doses had been administered worldwide, making it the fastest and largest vaccine rollout in history [6].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Flavia Moi, Văn Minh Nguyễn, Rachel Archer, Tozé Namalela, Christina Banks, Tarek Hossain, Afroja Yesmin, Cathbert Tumusiime, Charlotte Muheki, Kelsey Vaughan, Elise Smith, Rafael Deo Estanislao, Pierre Z. Akilimali, Hong Thi Duong, Chien Chinh Vien, Amélia Dipuve, Pedro Marizane Pota, Monjurul Islam, Paul Kiggundu, Okello Ayen Daniel, Sarah De Los Reyes, Jeremie de Guzman, Christelle Cuevas, Primrose Nakazibwe, Carl Schutte, Minh Van Hoang, Laura Boonstoppel. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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