The global community has set ambitious goals to look beyond national immunization coverage outcomes and prioritize communities that have been left behind from the advances made over the last decades. Reaching so-called zero-dose children, those that have missed out on all routine vaccines1, is a central pillar of both WHO’s Immunization Agenda 2030 and Gavi’s 5.0 strategy.
However, the COVID-19 pandemic has had a dramatic impact on widening inequities. Between 2019 and 2021 the number of zero-dose children increased by 3.2 million. To address these equity gaps, identifying efficiencies and exploring innovative delivery modalities to optimize resource allocation is more important than ever. However, economic evidence to support decisionmakers in this is lacking.
Estimating the costs and benefits of reaching zero-dose children will require a new way of thinking, including novel research design, methods, and metrics. Economic evidence for immunization programs is usually focused on estimating the average costs and benefits of reaching a broad population group, but reaching zero-dose children likely comes with increasing marginal costs. How to optimize the delivery strategy mix to reach a given community, and the relationship and tradeoff between equity and efficiency is not well-understood. At the same time, the benefits of reaching these communities may need to be estimated differently than is usually done, as overcoming the persistent barriers that immunization programs face, will also facilitate the delivery of other health services. Those that miss out on immunization services often miss out on other essential health and basic services as well, and economic studies will need to move away from vertical-program thinking and consider the costs and benefits of integrated delivery modalities.
REQUEST FOR EXPRESSIONS OF INTEREST
ThinkWell is currently seeking to select three countries to form the Hub, and welcomes expressions of interest (EOI) from interested research institutes based in low and middle-income countries to participate in the Hub. Hub members will generate critical economic evidence on reaching zero-dose children, and strengthen their capacity to conduct such economic analyses.
In each of the countries, local research institutes will facilitate the development of the scope of the study and work with the ministry of health to frame the research question. The researchers will lead the study design, implementation, and analysis, with coaching and mentoring support from ThinkWell, from global level methodological experts, and from each other. Throughout the project, research institutes will receive comprehensive support to strengthen their capacity to formulate a research ask, frame the scope, methods and outputs of the research, and in interpreting and translating research outcomes into policy and practice. To the extend possible, countries will be encouraged to include common themes and use common methods to facilitate cross-country learnings.
ThinkWell is looking for research institutes based in countries where the zero-dose agenda is a key political priority. Research institutes should have a high willingness to develop their capacity to conduct economic analysis to help improve immunization outcomes, and a curious and open mindset towards the development and application of novel methods to answering potentially complex research questions. Research institutes should be able to demonstrate a real interest in a long-term collaboration during which they will actively drive study design and implementation, and participate in collaborative Hub activities. The Hub will offer local researchers a global platform to share their research (including close collaboration with the Immunization Economics community of practice: http://www.immunizationeconomics.org), build their network, and facilitate ongoing learning opportunities, to ensure their continuation in this field of work after the project ends. This will be a 2.5 year commitment, with an expected start in February 2023.
Interested country-based research institutes can submit a short concept note to Rachel Archer (email@example.com) before the 31st of January 2023. The expression of interest should address the following:
- Outline 1-3 potential research questions and designs related to the economics of reaching zero-dose children. Please explain how these align to national priorities: the technical and political needs for economic evidence on addressing equity gaps, and how evidence will be used. Including a letter of support from the government for this work would be preferred.
- Elaborate on how you expect to work with the government, how you will ensure government ownership, and continuous involvement from government stakeholders throughout the project.
- Describe existing organizational capacity to conduct similar analysis, if any.
- Describe a capacity development strategy for the lifetime of the project, outlining the development objectives, and the institute’s preferred approach, including how it will specifically involve junior students/professionals and potentially government staff as well.
- Please elaborate on how you envision the collaboration with ThinkWell and other Hub members, including how we could best support you, and how you would support other members.
- Provide a high-level budget that includes the key activities that you would envision are part of this project.
- EOIs should not exceed 4 pages.