Vaccine reimbursement in low- and middle-income countries: bridging the gap between innovation and access

Key takeaway:

Effective vaccine reimbursement in LMICs requires reimbursement strategies that are designed for local health system realities, providing end to end support across the immunization ecosystem.

Breakthrough vaccine innovations, from mRNA platforms to combination vaccines targeting multiple pathogens, are transforming global health. Yet, in many low- and middle-income countries (LMICs), these advances fail to reach the people who need them most. The core challenge is not scientific innovation, but vaccine reimbursement systems that are unequipped to support adoption at scale. In LMICs, fragmented health systems, limited infrastructure and constrained budgets make it difficult to implement traditional funding models effectively. Reimbursement strategies that succeed in high-income settings therefore often falter when applied without adaptation to LMIC contexts. Successful vaccine reimbursement in LMICs requires strategic support across the entire immunization ecosystem, taking into account the broader context of health system capabilities, policy frameworks and economic constraints.

Why does vaccine reimbursement in LMICs require end-to-end support?

Unlike traditional pharmaceuticals, vaccines require robust infrastructure for delivery, storage and public engagement. In LMICs, where health systems may be under-resourced or fragmented, reimbursement strategies must be paired with comprehensive support for immunization programme design. This includes strengthening cold chain logistics, cohort optimization, workforce training and community outreach. Cross-functional collaboration across medical, regulatory and public affairs teams, combined with regular input from local affiliates, is essential for delivering comprehensive support grounded in real-world delivery contexts.

How can unmet need be demonstrated with limited local data?

With limited healthcare budgets, advocating for national immunization programme inclusion requires stronger value messaging around unmet need. One of the most persistent barriers to vaccine reimbursement in LMICs is the lack of local data. Without robust epidemiological evidence, it’s difficult to quantify unmet need or justify investment. Market access teams must work with local health systems to strengthen data collection, embrace alternative real-world data sources and use modelling tools to fill gaps where direct evidence is unavailable.

How do you build economic credibility for vaccines in resource-constrained settings?

Modelling infectious diseases for vaccines is uniquely complex due to the need to account for indirect effects like herd immunity, dynamic transmission patterns and long-term population-level impact. As many LMICs may have limited modelling capacity, economic evidence generated by supranational bodies carries additional weight. Market access teams must be prepared to advocate for the robustness and adaptability of their economic models while proactively addressing objections through tailored explanations that resonate with local decision-makers.

What role do supranational bodies play in vaccine reimbursement decisions?

Organizations like Gavi, the World Health Organization (WHO) and Pan American Health Organization (PAHO) play a critical role in shaping vaccine access in LMICs. Market access teams must engage proactively with these bodies to align on policy frameworks, funding mechanisms and technical guidance. Collaboration at this level can unlock pooled procurement opportunities and accelerate regional adoption.

Can pilot programmes reduce payer risk and unlock reimbursement?

To overcome payer hesitancy and logistical uncertainty, pilot programmes can be invaluable. These small-scale implementations allow stakeholders to test delivery models, gather local data and refine reimbursement strategies before national rollout. Support with designing and executing pilot programmes is a key enabler of broader vaccine access.

How can sustainable vaccine pricing be achieved?

Many LMICs operate within fragmented procurement ecosystems, where provincial, national and large private buyers each have distinct decision-making processes, budget constraints and timelines. Successful pricing negotiation requires a highly coordinated approach to engagement with a wide range of stakeholders, including supranational organizations such as Gavi and PAHO. While tiered pricing models are widely used to align affordability across countries with varying income levels, they can inadvertently trigger reference pricing dynamics, despite differences in procurement context or delivery infrastructure. Navigating these complexities therefore requires strategic coordination across geographies, clear communication of value, and careful management of pricing transparency to enable equitable access and long-term sustainability without undermining future negotiations.

Championing new evidence

Many LMICs lack the infrastructure and resources to monitor and respond to evolving evidence in real time. Developing a communications strategy that capitalizes on new evidence as an opportunity for reengagement can help secure more favourable reimbursement terms.

Conclusion

Vaccine reimbursement in LMICs is not simply a pricing challenge – it is a system-level issue that demands coordinated, evidence-driven and locally grounded strategies. When infrastructure challenges, policy alignment and stakeholder engagement are accounted for, vaccine reimbursement can translate into equitable access for all.

Not sure where to start with your vaccine reimbursement strategy? Our market access specialists are happy to help with any challenges you may be facing. Contact Emily Morton-West (emily.morton-west@amiculum.biz) to learn more.