Landscaping analysis of immunization progress and program structures in selected middle income Southeast Asian countries

This study examined the performance and structures of national immunization program in five middle-income Southeast Asian countries - Malaysia, Thailand, Philippines, Viet Nam, and Myanmar, and analyzed how the different structures relate to the difference in program performance to identify effective strategies in the study countries that facilitated good immunization performance. Data were derived from published literature, and WHO/UNICEF/Gavi databases, with 2010 as the baseline year. UMICs Malaysia and Thailand maintained ≥90 % coverage from 2010 to 2020 and even during the COVID-19 pandemic in 2021. LMICs Viet Nam and donor-supported Myanmar also achieved 80-90 % coverage for most routine vaccines in 2020. The Philippines have not reached ≥90 % coverage since 2010, with the maximum only 72 % (MCV1 and Polio3) in 2020. All study countries prioritize immunization and increased government financing since 2010 by minimum 91 % in Malaysia and 1897 % in Myanmar. However, Myanmar still largely depended on donor support with government financing only 32 % of immunization costs in 2021. The Philippines funds 100 % of immunization costs and ensures sustainable financing for the NIP through earmarked "sin tax" revenues from alcohol and tobacco. Donor support influenced new vaccine introductions among the study countries, with Gavi countries Myanmar and Viet Nam introducing more new vaccines, compared to Gavi-ineligible Malaysia and Thailand. The Philippines reported vaccine stock-outs every year amounting to 28 stock-outs events from 2010 to 2019, compared to only 1-4 stockouts in the other study countries. Donor support, innovative financing, and domestic vaccine manufacturing all play an important role in the efficient delivery of immunization services as demonstrated by the several new vaccine introductions and high immunization rates in Myanmar though Gavi and UNICEF support, additional annual $1.2 billion budget for health and immunization from "sin taxes" in the Philippines, and lack of stockouts for vaccines sourced at affordable prices from domestic manufacturers in Viet Nam.