Benefit-Cost Ratios of Continuing Routine Immunization During the COVID-19 Pandemic in Africa

Elizabeth Watts, Joshua Mak, Bryan Patenaude

Research output: Contribution to journalArticlepeer-review


Disruptions in routine immunization caused by COVID-19 put African countries with large vaccine-preventable disease burdens at high risk of outbreaks. Abbas et al. (2020) showed that mortality reduction from resuming immunization outweighs excess mortality from COVID-19 caused by exposure during immunization activities. We leverage these estimates to calculate benefit-cost ratios (BCRs) of disrupted immunization and apply cost of illness (COI) and value of statistical life-year (VSLY) approaches to estimate the cost of excess child deaths from eight vaccine-preventable diseases. BCRs were computed for each country, vaccine, and Expanded Program on Immunization visit. Secondary estimates that include the cost of providing immunization are presented in scenario analysis. Suspended immunization may cost $4949 million due to excess mortality using the COI approach, or $34,344 million using the VSLY approach. Likewise, excess COVID-19 deaths caused by exposure from immunization activities would cost $53 and $275 million using the COI and VSLY approaches, respectively. BCRs of continuing routine immunization are 94:1 using COI and 125:1 using VSLY, indicating that the economic costs of suspending immunization exceed that of COVID-19 deaths risked by routine immunization. When including the costs of providing routine immunization during the COVID-19 pandemic, the BCRs are 38:1 and 97:1 using the COI and VSLY approaches, respectively.

Original languageEnglish (US)
Pages (from-to)91-106
Number of pages16
JournalJournal of Benefit-Cost Analysis
Issue number1
StatePublished - Jan 18 2022


  • COVID-19
  • benefit-cost analysis
  • routine immunization
  • vaccines

ASJC Scopus subject areas

  • Sociology and Political Science
  • Economics and Econometrics
  • Public Administration


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