Armenia has strong immunization coverage, indicated by its 94% coverage of diphtheria-tetanus-pertussis (DTP3) in 2015, according to World Health Organization / UNICEF estimates. Since 2001, the country has used external support to spur new vaccine introduction and as of 2016 had the full list of WHO-recommended childhood vaccines except human papillomavirus (HPV), which was under consideration. Armenia is approaching the final stages of transitioning from Gavi support and has already transitioned from support from other donors. It has met 100% of its co-financing requirements for Gavi.
Armenia’s immunization program has benefited from strong political commitment from the Ministry of Health, the Ministry of Finance, and Parliament. The Ministry of Health shares immunization performance data, strategies, and policies with the Ministry of Finance. During the budget cycle, Armenia’s immunization program staff work closely with budget and finance staff in the Ministry of Health to prepare the budget. The immunization program has a key champion in Parliament, the chair of the Standing Committee on Health Care, Maternity, and Childhood.
Budget Processes and Vaccine Funding
Budget processes in Armenia clearly delineate budgets for vaccines and injection supplies and donor support. The budget line called “National Immunization Program” is specifically for vaccines and injection supplies. Financing for other immunization activities is integrated throughout the health system. All external support for immunization is accounted for in the budget. For example, the value of Gavi-supported vaccines is estimated in local currency and appears in the budget. In the past, Gavi financial support (vaccine introduction grants and health system strengthening grants) appeared in the budget in the extra-budgetary account.
The Ministry of Finance and Ministry of Health have a working agreement that calls for National Immunization Program funds to be released in full by the Ministry of Finance no later than April of each year so they can be transferred to UNICEF for the timely procurement of vaccines. The ministries also have a working agreement that the budget line is a “priority program” that must be protected even if other areas are facing budget cuts.
The Role of External Support
In strengthening and expanding its immunization program, Armenia has benefited from external support—primarily from Gavi, the Millennium Armenian Children’s Vaccine Fund (MACVF), the Rostropovich Vishnevskaya Foundation, UNICEF, and WHO. Both the MACVF and the Rostropovich Vishnevskaya Foundation are U.S.-based organizations. Long-term sustainability has been a consideration in planning for the use and phase-out of external assistance.
From 2002 to 2009, the Rostropovich Vishnevskaya Foundation, the MACVF, and UNICEF contributed funding to immunize children against measles, mumps, and rubella. These organizations funded the required doses, and the Ministry of Health covered the non-vaccine delivery costs. In 2010, the government assumed 100% of the financing for the vaccines. The Rostropovich Vishnevskaya Foundation, UNICEF, WHO, Fighting Infectious Diseases in Emerging Countries (FIDEC) Armenia, and the MACVF provided the funding for a campaign in 2007 to vaccinate people age 6 to 27 against measles and rubella.
The government introduced the hepatitis B, rotavirus, pneumococcal, and inactivated polio vaccines with Gavi support. (The hepatitis B vaccine was later replaced by pentavalent, while the birth dose of hepatitis B was maintained.) It also received financial support from Gavi for health system strengthening and injection safety support. Armenia has met its annual co-financing obligations to Gavi by procuring some of the doses itself (through UNICEF), with Gavi financing the remaining share. The MACVF provided some of the funding for the co-financing requirements for pentavalent and rotavirus (about US$15,000 per year), with the government providing the rest. This arrangement ended in 2015.
The immunization program procures all vaccines from UNICEF Supply Division, with the exception of tularemia vaccine. Armenia’s national immunization technical advisory group (NITAG) is currently reviewing the effectiveness of this vaccine.
One of the continuing challenges is the lack of trust in vaccines among some segments of the population. The Ministry of Health monitors popular parent websites and promptly responds to questions and concerns about vaccine efficacy and safety.