Vietnam’s Vaccine Problem: Who Pays?

Centralizing funding to add two new vaccines to Vietnam’s national immunization program would prevent thousands of deaths and save tens of millions of dollars in healthcare costs. According to an analysis by researchers from the Duke Global Health Institute and Duke Kunshan University. 

The findings, which were shared at a conference on Jan. 28 in Hanoi, follow a series of rapid policy reversals as Vietnam seeks to navigate funding and logistical challenges in rolling out its expanded vaccine strategy. The researchers hope to offer a road map for middle-income countries to ramp up domestic funding of vaccine campaigns as they transition away from international aid.

“Like many middle-income countries, Vietnam is facing reductions in international aid and needs to establish effective and sustainable domestic funding mechanisms to support its immunization program, says Shenglan Tang, M.D., Ph.D., a DGHI professor who leads the Innovation Lab for Vaccine Delivery Research (VaxLab at Duke Kunshan University. “We are working to help them craft evidence-based policies that fit the country’s unique contexts.”

Vietnam launched plans in 2021 to add two vaccines considered essential by the World Health Organization -- pneumococcal conjugate vaccines (PCVs) and vaccines for HPV, the virus that causes most cases of cervical cancer – to its national immunization program. As the country’s economy has grown, however, it has graduated from funding available through the Global Vaccine Alliance (GAVI) to assist low-income countries in supporting vaccine campaigns. Facing declining international aid, Vietnam moved in 2023 to shift responsibility for funding the expansion to provincial governments, leading to widespread vaccine shortages and the largest decline in childhood immunization rates in two decades. 

While the government ended the experiment just a few months after it began, its failure had significant consequences. According to a study published by Tang’s team in 2025, decentralization left many rural provinces unable to afford or access vaccines, leaving thousands of children unprotected from vaccine-preventable diseases and exacerbating socioeconomic disparities. 

“We have learned valuable lessons from our past experiences with decentralizing and then re-centralizing financing for immunization,” says Nguyen Khanh Phuong, Ph.D., director of Vietnam’s Health Strategy and Policy Institute (HSPI), which collaborated on the research. ”We now understand that while local engagement is vital, a fragmented approach can threaten equity and health security."

The VaxLab team found that nationalizing financing for the expanded vaccine program is both cost-effective and likely to deliver significant health benefits. According to the aanalysis, nationwide access to PCV immunization alone would prevent 1.2 million illnesses and around 5,000 deaths by 2030, while saving the health system tens of millions of U.S. dollars in treatment costs. The report also noted that expanding access to HPV vaccines would significantly reduce the incidence of cervical cancer, which remains among the most common forms of cancer among women in Vietnam.

The January conference, co-hosted by the VaxLab and HSPI, was attended by representatives of Vietnam’s national and provincial governments, as well as academic and health organizations and vaccine manufacturers. Discussions touched on many technical and logistical challenges to expanding vaccine access, including human resources, cold-chain systems, public health messaging and safety monitoring. 

The research was funded primarily through a grant from The Gates Foundation. The University of Sydney, Australia, provided technical support and analysis related to HPV.

“As Vietnam navigates the transition away from international donor support, these rigorous studies on vaccine financing are essential for national sovereignty in public health,” says Phuong. “The evidence generated through our partnership provides the scientific foundation needed to secure domestic resources and make informed decisions, ensuring that every Vietnamese citizen can benefit from a robust and self-reliant immunization program.”