The Knowledge Hub

What is the Knowledge Hub?

Explore the VoICE Knowledge Hub—a searchable database featuring the latest peer-reviewed research on immunization benefits, especially in low- and middle-income countries. Browse the Knowledge Hub using a variety of different filters to find vaccine evidence based on country, region, topic, or disease. Click on a tag to find more evidence on a specific area, such as the return on investment of vaccines or impacts of infectious disease outbreaks.


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During a meningitis outbreak in Burkina Faso, families spent $90 on treatment, causing financial strain and loss of income

During a meningococcal meningitis epidemic in Burkina Faso, households spent, on average, US$90 for treatment and other direct costs for family members with the disease. These costs, the equivalent of one third of the country’s annual GDP per capita, were in addition to the loss of income and assets from family members caring for patients.

Colombini A, Badolo O, Gessner BD et al.. 2011. Costs and impact of meningitis epidemics for the public health system of Burkina Faso. Vaccine. 29(33).

Dengue illness is costly for low-income families, but immunization can help reduce the economic burden

In a standardized survey of the costs of dengue illness in three highly endemic countries, the economic burden of dengue was greatest on Vietnamese and Colombian low-income families, whose total costs, including lost wages, outpatient and inpatient cases combined, average 36-45% of their monthly household income. In Thailand, although significant, the economic burden was 17% less than the other countries, due to Thailand’s universal health insurance system.

Lee JS, Mogasale, V, Lim JK et al. 2017. A multi-country study of the economic burden of dengue fever: Vietnam, Thailand, and Colombia. PLoS NTD. 11(10).

Hospitalization for pneumonia in children causes financial burdens for families beyond medical treatment

Three studies in Bangladesh and India found that the direct medical costs for children hospitalized with pneumonia were 27% to 116% of the average monthly income of households. And, while these costs represent a major portion of a family’s monthly income, they don’t include non-medical costs, such as transport and food costs, nor the lost wages of family members who miss work to care for the child.

Zhang S, Sammon PM, King I, et al.. 2016. Cost of management of severe pneumonia in young children: systematic analysis. Journal of Global Health. 6(1).

Immunization can prevent costly hospitalizations for childhood pneumonia, saving money and improving health outcomes

In a global review of the costs of treating childhood pneumonia, the average costs of a hospitalized case of pneumonia in children under five years of age was US$243 in primary or secondary hospitals in low- and middle-income countries (ranging from US$40 – US$563) and US$559 in tertiary hospitals (ranging from US$20 – US$1,474). In high-income countries, the cost of hospitalized cases averaged US$2,800 in primary or secondary hospitals and more than US$7,000 in tertiary hospitals. Note that in most of these studies, only direct medical costs were included and thus total costs – including non-medical costs and lost wages – would be considerably higher.

Zhang S, Sammon PM, King I, et al.. 2016. Cost of management of severe pneumonia in young children: systematic analysis. Journal of Global Health. 6(1).

Immunization can prevent costly meningitis outbreaks and protect households from financial burden and lost income

A 2006-07 meningococcal meningitis epidemic in Burkina Faso cost households an average of US$90 for each case of meningitis that occurred. These costs — representing nearly 2.5 months of the average per capita income for that year — included direct and indirect costs of treatment and lost income to caretakers.

Colombini A, Bationo F, Zongo S, et al.. 2009. Costs for households and community perception of meningitis outbreaks in Burkina Faso. Clinical Infectious Disease. 49(10).

Immunization can prevent families from facing financial hardship due to expensive medical treatments

Costs for treatment for rotavirus at a large urban hospital in Malaysia led one third of families to experience catastrophic health expenditures (CHC). When direct and indirect costs of treating rotavirus were considered, almost 9 in 10 families spent more than 10% of their monthly household income on treating rotavirus. In addition, 6% of families were pushed into poverty after paying for treatment.

Loganathan, T., Lee, W.S., Lee, K.F., et al. 2015. Household Catastrophic Healthcare Expenditure and Impoverishment Due to Rotavirus Gastroenteritis Requiring Hospitalization in Malaysia. PLOS One. 10(5).

Immunization helps protect low-income populations from financial burden and prevents diseases like measles and pneumonia

In a financial risk model analysis of 41 Gavi-eligible countries, the burden of Catastrophic Health Costs (CHC) and Medical Impoverishment (MI) would be greatest in the lowest income populations. With expanded vaccine coverage, the share of prevented cases of measles, pneumococcal disease, and rotavirus, in relation to the total number of cases prevented, would be larger in the lowest income populations thereby providing a larger financial risk protection (FRP) to these populations.

Riumallo-Herl, C., Chang, A.Y., Clark, S., et al.. 2018. Poverty reduction and equity benefits of introducing or scaling up measles, rotavirus, and pneumococcal vaccines in low-income and middle-income countries: a modeling study. British Journal of Medicine Global Health. 3:e000612.

Immunization can prevent medical debts and improverishment, particularly in the poorest populations

A study modeling the economic impact of 10 childhood immunizations in 41 low- and middle-income countries found that the bulk of poverty averted through vaccination occurs in poor populations. For most of the vaccines in the study, at least 40% of the poverty averted would occur in the poorest wealth quintile. Particularly for pneumonia, more than half of the two million deaths averted by pneumococcal and Hib vaccines would occur in the poorest 40% of the population.

Chang, A.Y., Riumallo-Herl, C., Perales, N.A., et al.. 2018. The equity impact vaccines may have on averting deaths and medical impoverishment in developing countries. Health Affairs. 37(2).

Episodes of dengue can cause catastrophic health costs for households

In a 2002 study from Cambodia, households with a dengue patient had to borrow money at high interest rates and lose productive assets (land) to repay debts linked to healthcare costs. Public healthcare cost significantly less than private healthcare but was either not present where people lived or did not have a good reputation.

Van Damme, W., Van Leemput, L., Por, I., et al. 2004. Out-of-pocket health expenditure in poor households: evidence from Cambodia. Tropical Medicine and International Health. 9(2).

Childhood diarrheal disease imposes a heavy financial burden on healthcare and households, potentially leading to impoverishment

In Malawi, in 17% of cases where children were admitted to the hospital, and in 9% of cases where children were treated as outpatients for diarrhea, household costs associated with treating that episode, exceeded monthly income in a significant number of cases. The costs were significant enough to push families from each income level below the national poverty line for the month in which the illness occurred.

Hendrix, N., Bar-Zeev, N., Atherly, D., et al. 2017. The economic impact of childhood acute gastroenteritis on Malawian families and the healthcare system. BMJ open. 7(9).