Expenditures on vaccine-preventable disease surveillance: Analysis and evaluation of comprehensive multi-year plans (cMYPs) for immunization.

Despite the importance of vaccine-preventable disease (VPD) surveillance, little is known about the costs of monitoring disease. We used Comprehensive Multi-Year Plans for Immunization (cMYPs) - developed by countries following guidelines from the World Health Organization and United Nations Children's Fund - to estimate expenditures on VPD surveillance at the country level in 2015 US Dollars (USD) in 63 low- and middle-income countries. To evaluate the reliability of cMYP estimates, we also compared cMYP data with findings from previous research studies and assessed whether countries explicitly budgeted for major categories of surveillance activities in their plans for immunization. According to our analysis of cMYPs, countries spent an annual median of $406,108 on VPD surveillance ($0.04 per capita and $1.47 per infant), with reported expenditures ranging from $1,098 (Kiribati) to $21,644,770 (Nigeria). However, the majority of countries failed to explicitly mention several key categories of surveillance activities in their plans, especially laboratory-related surveillance activities. Our results show a large amount of variation in surveillance expenditures (total, per capita, and per infant) between countries and provide insights to improve costing guidelines and practices.