Estimating the Global, Regional, and National Economic Costs of COVID-19 Vaccination During the COVID-19 Pandemic

<b>Background:</b> The COVID-19 pandemic led to an unprecedented global health and economic crisis, and vaccination emerged as a critical intervention to control the spread of the virus and mitigate its impact on health systems and economies. Despite the rapid development and deployment of vaccines, the financial commitments required for these vaccination programs are substantial, necessitating a comprehensive understanding of the associated costs to inform future public health strategies and resource allocation. <b>Method:</b> This analysis estimates the global, regional, and national economic costs of COVID-19 vaccination across 234 countries and regions in the period 2020-2023, consisting of vaccine procurement costs and administration costs. <b>Result:</b> As of 31 December 2023, the global costs of COVID-19 vaccination programs were estimated at USD 246.2 billion, with vaccine procurement accounting for approximately USD 140.2 billion and administration costs totaling USD 96.4 billion. Globally, a cumulative total of 136.9 billion doses of COVID-19 vaccines had been administered. Factoring in an estimated wastage rate of 10%, it is projected that approximately 150.6 billion doses were used. On a global scale, the average number of vaccine doses administered per capita was estimated at 1.73. The mean cost per capita was USD 17.70 (95% CI: USD 15.84-19.56) for vaccine procurement and USD 12.16 (95% CI: USD 10.29-14.02) for administration, resulting in a total average cost of USD 29.85 (95% CI: USD 26.33-33.37) per capita. Significant disparities in costs were observed across income groups and regions. High-income countries incurred a notably higher average cost per capita of USD 76.90 (95% CI: USD 72.38-81.41) in contrast to low-income countries, where the per capita cost was USD 7.20 (95% CI: USD 5.38-9.02). For middle-income countries, the average per capita costs were USD 15.02 (95% CI: USD 10.64-19.40) in lower-middle-income countries and USD 28.21 (95% CI: USD 23.60-32.83) in upper-middle-income countries. Regionally, the Americas (AMR) reported the highest total cost at USD 70.8 billion, with an average per capita cost of USD 65.23 (95% CI: USD 56.18-74.28). The Western Pacific Region (WPR) followed with a total cost of USD 63.9 billion and an average per capita cost of USD 31.93 (95% CI: USD 20.35-43.51). Conversely, the African Region (AFR) had the lowest total spending at USD 10.8 billion and a per capita cost of USD 8.85 (95% CI: USD 5.34-12.37), reflecting both lower vaccine procurement and administration costs. The European Region (EUR) recorded a high average per capita cost of USD 53.36 (95% CI: USD 46.79-59.94), with procurement costs at USD 31.28 (95% CI: USD 27.41-35.14) and administration costs of USD 22.09 (95% CI: USD 19.31-24.87). <b>Conclusions:</b> The global rollout of COVID-19 vaccination revealed substantial variation in cost structures across income groups. Procurement costs imposed greater burdens on low- and lower-middle-income countries, whereas delivery and administration costs dominated in higher-income settings. These disparities highlight persistent fiscal inequities and emphasize the need for stronger international coordination and cost transparency to enhance equity, efficiency, and preparedness in future vaccination efforts.