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Background The COVID-19 pandemic affected hundreds of millions of people and lives, and vaccination was the safest and most effective strategy to prevent and mitigate the burden of this disease. The implementation of COVID-19 vaccination in Vietnam in 2021 was unprecedentedly challenging in scale and complexity, yet economic evidence on the cost of delivery vaccines thought the program was lacking. Methods This retrospective costing study utilized a bottom-up, ingredient-based approach to estimate the cost of delivering COVID-19 vaccines in Vietnam in 2021, from a payer perspective. The study included 38 study sites across all administrative and implementation level, including three geographic areas and two delivery strategies, in two provinces, Hanoi and Dak Lak. The study findings were complemented with qualitative interviews with health staff and stakeholders. Results The economic cost to deliver one COVID-19 vaccine dose was $1.73, mostly comprised of opportunity costs ($1.14 per dose) which were driven by labor costs ($1.12 per dose). The delivery cost in urban areas was the highest ($2.02), followed by peri-urban areas ($1.45) and remote areas ($1.37). Delivery costs were higher at temporary sites ($1.78) when compared to facility-based delivery ($1.63). Comparing low-volume and high-volume periods showed that the delivery cost decreased significantly as volume increased, from $5.24 per dose to $1.65 per dose. Conclusions The study estimates the cost of delivering COVID-19 vaccines in Vietnam in 2021. Enabling factors and challenges during the implementation of the program were explored. Study limitations may lead to underestimation of results and reduce generalizability.

Background Vaccines were a key tool in controlling the COVID-19 pandemic. However, the cost of delivering these vaccines in low- and middle-income countries was highly uncertain, due to the unprecedented delivery volume and the need to reach new target populations. To fill this evidence gap, this study estimates the cost of delivering COVID-19 vaccines in Mozambique. Methods This retrospective, bottom-up costing study estimated the financial and economic costs of delivering COVID-19 vaccines in 2022 USD, during the first year of introduction. Recurrent costs were collected for the initial rollout period (March 8th to April 8th 2021) and for a later, higher-volume period (December 1st 2021 to February 28th 2022). The study was conducted from a payer perspective. Data was collected at health facilities from a purposively selected sample of 27 vaccination sites, as well as from 6 district and provincial health offices in 2 provinces, the Ministry of Health, and development partners. The overall cost per dose was obtained by estimating and aggregating the volume-weighted average cost per dose for each administrative level. Qualitative interviews were also conducted to contextualize cost findings. Results The cost per dose for the first year of implementation was $1.14 for economic costs and $0.50 for financial costs. For the initial rollout period, when the volume delivered was low (64 doses/vaccination day on average), the economic cost per dose was $3.56 and decreased considerably to $0.85 when the program delivered at scale and volume delivered increased to 225 doses/vaccination day. Opportunity costs made up a considerable share of the economic cost per dose, 73% and 49% respectively during the initial rollout and when the program delivered at scale. The qualitative interviews found that political prioritization and workers’ commitment made the program possible despite little financial investment. Conclusions The cost of delivering COVID-19 vaccines in Mozambique was found to be low compared to other countries, due to heavy reliance on existing resources and little additional investment into the program. Findings from this study can support the government in planning and budgeting for the future of the COVID-19 vaccination program as well as other vaccination efforts.

Background To improve the efficient use of scarce resources, low- and middle-income countries and development partners are increasingly encouraged to deliver multiple vaccines and other interventions in a single integrated campaign. However, little is known regarding the cost of delivering vaccines through integrated campaigns, and the extent to which efficiencies are achieved. To fill this evidence gap, we estimated the cost of integrated immunization campaigns in Nigeria and Sierra Leone, and the potential savings from integration. Methods We conducted a retrospective ingredients-based costing study from a payer perspective of a campaign held in 2019 in Sierra Leone with measles-rubella vaccine and oral polio vaccine, during which nutrition supplements were also offered in part of the country, and yellow fever campaigns held in three states in Nigeria in 2019 and 2020, where in one state (Anambra) meningococcal A vaccines were co-delivered. We collected data from 108 health facilities, all relevant administrative levels, and implementing partners. We estimated the full financial and economic cost of each campaign, the average unit cost of delivery, as well as the cost by activity and resource type. We also estimated the cost savings from integration in Anambra state by modelling out the cost of the alternative of two standalone campaigns. Results The average financial delivery cost was $0.34 per dose in Sierra Leone, and the economic cost was $0.73 per dose. In Nigeria, the financial cost per dose was $0.29–$0.35 across the three states, and the economic cost per dose was $0.62–$0.85. Facilities and wards delivering more doses achieved a lower financial and economic unit cost of delivery, demonstrating evidence of economies of scale. We estimated that Anambra may have saved at least $1,204,133 in financial resources by integrating yellow fever and meningitis A vaccine delivery, amounting to $0.17 per dose delivered. When including opportunity costs, the economic cost saving was estimated at $0.34 per dose delivered. Conclusions The study offers evidence on what it costs to deliver integrated campaigns, and shows that integrated delivery is likely to result in significant cost savings. Where high delivery volumes can be achieved, integrated campaigns can benefit from economies of scale. The findings can be used to inform planning and budgeting for immunization campaigns in low- and middle-income countries.

While COVID-19 vaccines were crucial in containing the pandemic, there is limited evidence on the cost of delivering them in low- and middle-income countries. We estimated the cost of delivering COVID-19 vaccines in Bangladesh, Côte d'Ivoire, the Democratic Republic of the Congo, Mozambique, the Philippines, Uganda, and Vietnam. We retrospectively estimated the financial and economic cost of COVID-19 vaccine delivery from a payer perspective, using a bottom-up approach. Cost data were collected from 290 sites, while qualitative interviews were conducted with 192 key informants. We estimated volume-weighted average costs per dose in 2022 USD, for introduction phases, delivery modalities, and strategies. The financial cost per dose ranged from $0·29-$2·18 across countries, driven by per diem and supplies. The economic cost per dose ranged from $1·14-$9·50, driven by the cost of labor. Newly hired health workers were a cost driver only in the Philippines. The economic delivery cost per dose was inversely correlated with daily vaccine volume delivered at vaccination sites. Similarly, delivering through campaigns came at a lower unit cost than continuous delivery, and when programs scaled up, the cost per dose decreased dramatically. Political prioritization, health workers' commitment, and volunteers were highlighted as success factors, while resource constraints at implementation level and health workers shortages were flagged as key challenges. Our findings demonstrate how under-resourced health systems managed to deliver massive amounts of vaccines with relatively few resources. However, they also expose significant gaps and inefficiencies, and underscores the need to invest in resilient health systems to improve future pandemic responses.

The COVID-19 pandemic has disrupted immunization services critical to the prevention of vaccine-preventable diseases in many low- and middle- income countries around the world. These services will need to be modified in order to minimize COVID-19 transmission and ensure the safety of health workers and the community. Additional budget will be required to implement these modifications that ensure safe delivery. Using a simple modeling analysis, we estimated the additional resource requirements associated with modifications to supplementary immunization activities (campaigns) and routine immunization services via fixed sites and outreach in 2020 US dollars. We considered the following four categories of costs: (1) personal protective equipment (PPE) & infection prevention and control (IPC) measures for immunization sessions; (2) physical distancing and screening during immunization sessions; (3) delivery strategy changes, such as changes in session sizes and frequency; and (4) other operational cost increases, including additional social mobilization, training, and hazard pay to compensate health workers. We found that implementing a range of measures to protect health workers and communities from COVID-19 transmission could result in a per-facility start-up cost of $466–799 for routine fixed-site delivery and $12–220 for routine outreach delivery, and $12–108 per immunization campaign site. A recurrent monthly cost of $137–1,024 for fixed-site delivery and $152–848 for outreach delivery per facility could be incurred, and a $0.32–0.85 increase in the cost per dose during campaigns. By illustrating potential cost implications of providing immunization services through a range of strategies in a safe manner, these estimates can provide a benchmark for program managers and policy makers on the additional budget required. These findings can help country practitioners and global development partners planning the continuation of immunization services in the context of COVID-19.

In the Brazilian context, the dizzying growth of archaeological investigations related to heritage preservation is a consequence of the democratization of the country and the adoption of public policies that foster citizen participation in the management of their own cultural heritage. This growth has created a forum for discussion about archaeological and heritage issues and their relationship to the wider realm of economy, culture, politics, ethics, and government as well as to social, educational, and management aspects. There has also been a gradual growth in the promotion of the rights of indigenous people to make and take part in decisions about the treatment, interpretation, and management of their sites and objects.

Sur la base d’une enquête ethnographique dans les manufactures textiles d’art françaises et italiennes, cet article interroge le régime de propriété du savoir-faire dans le tissage Jacquard. Il s’agira de décrire l’activité de tisserands et ingénieurs au métier et autour de celui-ci dans la conception et dans la réalisation de motifs et textures, et d’analyser, d’une part, la distribution de faire et savoirs entre les acteurs, et, d’autre part, la relation que ceux-ci entretiennent avec le tissu et la machine. On the basis of an ethnographic investigation in French and Italian art textile factories, this article addresses the property regime associated with jacquard weaving. It describes the activity of weavers and engineers at and around the loom in the design and production of patterns and textures. The article analyses, on the one hand, the sharing of knowledge between weavers and, on the other hand, the relationship between weavers, the fabric and the machine.

C’est dans le contexte de la Sicile à l’époque archaïque et classique que s’inscrit cette étude qui cherche à mettre en évidence certains aspects des débats concernant le problème de la terre dans le monde grec. En effet, une grande variété de solutions, même extrêmes, y furent expérimentées aussi bien du point de vue de la subdivision de la terre, en tant que bien primaire destiné à produire et élément de qualification civique, que d’un point de vue plus large, à savoir celui du territoire. Après avoir souligné le caractère abstrait des analyses faisant référence aux seules formes de la répartition primaire de la propriété foncière dans le monde colonial, l’étude se concentrera sur la question de la possession de la terre en tant qu’élément essentiel de la reproduction du système-polis. Cela permet de mieux comprendre les phénomènes de continuité coloniale, tout particulièrement celui de colonisation secondaire ou de seconde génération dont la Sicile offre des exemples significatifs. Bien différentes semblent être les expériences politiques des Ve et IVe siècles, spécifiquement celles liées aux tyrans : la répartition de la terre, s’inscrivant dans des conceptions politiques et stratégiques complexes, laisse alors supposer un nouveau rapport à la propriété foncière et au travail agricole, et, en parallèle, le développement d’une logique territoriale à une échelle anormale pour la polis traditionnelle. Based on the historical framework of Sicily during the archaic and classical periods, the paper aims at an assessment of some of the debated issues concerning land in the Greek world. Indeed, a great variety of solutions, even exceptional, were experimented in that context as regards the division of productive land, both as shared primary resource and as qualification in a civic context. But here land acquired also a different significance as a key to extended territorial definitions. After pointing out the abstractness of focusing only on formal aspects of land distribution in the colonial world, land ownership is considered as an essential element in reproducing the polis-system. This allows a better understanding of colonial continuity, namely secondary colonization, which is remarkably typified in Sicily. Quite differently, in the fifth and fourth centuries, the politics of some powerful tyrants,framing the issue of land within more complex strategic designs, suggests that a different and new value of landed property and agricultural work is developing, on the one hand, and, on the other, that a territorial logic, anomalous for the traditional polis, is set out.