Optimizing Vaccine Delivery Costs: Modeling the Impact of Key Operational Levers in a Northern Nigerian State

Background: Efficient vaccine delivery systems are critical for sustaining high immunization coverage in low- and middle-income countries (LMICs). However, cost optimization remains a persistent challenge. This study assessed the cost drivers of vaccine delivery in Kano State, Nigeria, and modeled the effects of key operational levers to inform supply chain strengthening efforts. Methods: We conducted a retrospective cost analysis of vaccine deliveries to 390 health facilities in Kano State under both government-run and outsourced distribution models. Costs were categorized into labor, transportation, storage, building, and communication components. We modeled variations in delivery layers, delivery frequency, fleet types, and number of delivery points using Microsoft Excel and STATA 13 SE. Statistical tests included Kruskal-Wallis, Tukey post-hoc, and Mann-Whitney U analyses. Results: Five operational levers including automobile options, delivery frequency, number of delivery points, number of delivery layers, and responsibility for vaccine distribution, significantly influenced unit delivery costs. Streamlining delivery layers reduced costs by up to 38%, while transitioning from outsourced to government-run models lowered costs by up to 28% (p < 0.05). Increasing the number of delivery points and using motorcycles or tricycles instead of trucks further reduced unit costs by 15–34%. However, increased delivery frequency, while reducing unit costs per cycle, raised total annual operational costs. Conclusions: Optimizing supply chain design through strategic adjustments in delivery models, vehicle selection, and facility coverage can substantially lower vaccine delivery costs in resource-constrained settings. Policymakers should integrate cost-efficiency strategies into immunization system strengthening initiatives to enhance sustainability and resilience, particularly in the post-pandemic recovery era.