Evaluating the Health Opportunity Costs of COVID-19 Pandemic Prevention,  Preparedness, and Response Investment: A Comparative Analysis With Primary Healthcare System Strengthening

Meixi Jiao

doi:10.54691/hr5hz710

Authors

Meixi Jiao

DOI:

https://doi.org/10.54691/hr5hz710

Keywords:

COVID-19; Pandemic Preparedness; Health Opportunity Cost; DALY; Universal Health Coverage; Primary Healthcare; Vaccine Investment; Global Health Financing.

Abstract

This study evaluates the health opportunity costs associated with the allocation of global health resources toward pandemic prevention, preparedness, and response (PPPR) for COVID-19 compared to alternative investments in primary healthcare system strengthening. A central tension in global health policy involves the allocation of finite resources between vertical programs targeting specific diseases and horizontal investments that strengthen foundational health systems. This research addresses this critical resource allocation question by quantifying the health gains derived from $15.25 billion invested through the International Finance Facility for Immunization (IFFIm) and the COVAX Advance Market Commitment (AMC) for COVID-19 vaccine procurement during 2020-2024. Using disability-adjusted life years (DALYs) as the primary outcome measure, the study constructed a counterfactual scenario in which identical resources were allocated to the World Bank's Essential Universal Health Coverage (EUHC) package for low-income countries. Under benchmark assumptions employing a median vaccine price of $13.17 per dose and a number needed to vaccinate (NNV) of 1,000, the factual PPPR investment yielded 22.1 million DALYs averted, while the counterfactual primary healthcare investment would have averted 16.01 million DALYs. The resulting opportunity cost of -6.09 million DALYs indicates that PPPR investment outperformed the alternative scenario. Sensitivity analyses confirmed the robustness of this finding across most parameter variations, with positive opportunity costs emerging only under highly optimistic assumptions regarding primary healthcare delivery efficiency. These findings suggest that emergency pandemic vaccine procurement represented a cost-effective resource allocation strategy from a population health perspective, though sustained investment in primary healthcare remains essential for long-term health system resilience.

Downloads

Download data is not yet available.

References

[1] Adams, K., Riddles, J. J., Rowley, E. A. K., Grannis, S. J., Gaglani, M., Fireman, B., Hartmann, E., Naleway, A. L., Stenehjem, E., Hughes, A., Dalton, A. F., Natarajan, K., Dascomb, K., Raiyani, C., Irving, S. A., Sloan-Aagard, C., Kharbanda, A. B., DeSilva, M. B., Dixon, B. E., & Tenforde, M. W. (2023). Number needed to vaccinate with a COVID-19 booster to prevent a COVID-19-associated hospitalization during SARS-CoV-2 Omicron BA.1 variant predominance, December 2021–February 2022, VISION Network: A retrospective cohort study. The Lancet Regional Health – Americas, 23, 100530. https://doi.org/10.1016/j.lana.2023.100530.

[2] Eaneff, S., Boyce, M. R., Graeden, E., Lowrance, D., Moore, M., & Katz, R. (2023). Financing global health security: Estimating the costs of pandemic preparedness in Global Fund eligible countries. BMJ Global Health, 8(1), e008960. https://doi.org/10.1136/bmjgh-2022-008960.

[3] Gavi. (2021, June 2). World leaders unite to commit to global equitable access for COVID-19 vaccines. https://www.gavi.org/news/media-room/world-leaders-unite-commit-global-equitable-access-covid-19-vaccines.

[4] Gavi. (2024, January 15). Gavi COVAX AMC. https://www.gavi.org/gavi-covax-amc.

[5] IFFIm. (n.d.). Impact. Retrieved November 9, 2025, from https://iffim.org/impact.

[6] IFFIm. (2020). Annual report of the trustees and financial statements for 2020. https:// iffim. org/ sites/ default/files/trustees-reports/IFFIm-2020-Trustees-Report-and-Financial-Statements.pdf.

[7] IFFIm. (2021). Annual report of the trustees and financial statements for 2021. https:// iffim. org/ sites/ default/files/trustees-reports/IFFIm-2021-Trustees-Report-and-Financial-Statements.pdf.

[8] IFFIm. (2022). Annual report of the trustees and financial statements for 2022. https://iffim. org/ sites/default/files/trustees-reports/IFFIm-2022-Trustees-Report-and-Financial-Statements.pdf.

[9] IFFIm. (2023). Annual report of the trustees and financial statements for 2023. https:// iffim. org/ sites/default/files/trustees-reports/IFFIm-Annual-Report-of-the-Trustees-and-Financial-Statements-2023.pdf.

[10] IFFIm. (2024). Annual report of the trustees and financial statements for 2024. https:// iffim. org/ sites/default/files/trustees-reports/IFFIm-2024-Trustees-Report-and-Financial-Statements.pdf.

[11] Jamison, D. T., Gelband, H., Horton, S., Jha, P., Laxminarayan, R., Mock, C. N., & Nugent, R. (Eds.). (2018). Disease control priorities: Improving health and reducing poverty (3rd ed., Vol. 9). World Bank. https://doi.org/10.1596/978-1-4648-0527-1.

[12] Lay, K. (2025). IFFIm report: IFFIm contribution to Gavi's funding requirements. IFFIm.

[13] Tacheva, B., Brown, G. W., Bell, D., & Von Agris, J. (2025). The devil's in the detail: An appraisal of the use of innovative financing mechanisms for pandemic prevention, preparedness, and response. Globalization and Health, 21(1), 13. https://doi.org/10.1186/s12992-025-01103-w.

[14] UK Health Security Agency. (2023). Appendix 1: Estimation of number needed to vaccinate to prevent a COVID-19 hospitalization for primary vaccination, booster vaccination (3rd dose), autumn 2022 and spring 2023 booster for those newly in a risk group.

[15] UNICEF. (n.d.). COVID-19 market dashboard. Retrieved November 13, 2025, from https:// www. unicef. org/supply/covid-19-market-dashboard.

[16] Watkins, D. A., Jamison, D. T., Mills, A., Atun, R., Danforth, K., & others. (2018). Annex 3C: Essential universal health coverage: Interventions and platforms. In D. T. Jamison et al. (Eds.), Disease control priorities: Improving health and reducing poverty (3rd ed., Vol. 9). World Bank.

[17] World Health Organization & World Bank. (2022). G20 gaps in PPR financing mechanisms. https: // www.who.int/publications.