Cost analysis of overseas versus domestic vaccination of US-bound refugees

Context

To ensure healthy resettlement and protect US health security, the Vaccination Program for US-bound Refugees (VPR) offers some recommended vaccines to refugees overseas before resettlement to the United States. The selected vaccines and number of doses vary by country of departure. VPR was found to be cost-saving in 2018 but had since expanded to more sites.

Objective

Assess VPR’s current costs and impact on post-arrival domestic vaccination needs and costs.

Setting and Participants

A model-based analysis of the Federal government costs for VPR and post-arrival (US) vaccination of resettled refugees separated across five regions: Africa, Asia, the Middle East and North Africa/Republic of Türkiye and Middle East, Europe, and the Americas using fiscal year 2024 data.

Design

We quantified and compared full vaccination costs for refugees under two scenarios: (1) ‘No VPR’ and (2) ‘VPR’. Refugees would receive no vaccines overseas and be fully vaccinated after US arrival under ‘No VPR’. Under ‘VPR’, refugees receive one or two doses of selected vaccines overseas before completing vaccination schedules after arrival.

Main Outcomes

Costs were reported in 2023 US dollars for ‘VPR’ and ‘No VPR’ scenarios and further subdivided by grouping countries/sites depending on whether the International Organization for Migration (IOM) provides vaccination services for refugees (IOM sites) versus non-IOM providers (non-IOM sites).

Results

‘VPR’ resulted in average net cost savings of $147 per person or $14.7 million per 100,000-refugee cohort compared to providing all vaccines after US arrival (‘No VPR’). ’VPR’ was cost-saving across most regions, except for IOM sites in Europe, where a net cost of $44 per person was observed. Net cost savings per person were highest for IOM sites in Africa ($333).

Conclusions

VPR remains a cost-saving strategy, while protecting US-bound refugees’ health and US health security by preventing disease outbreaks during resettlement.

Implications for Policy & Practice

• The Vaccination Program for US-bound Refugees (VPR) provides some vaccines to refugees overseas, before they depart for the United States.

• VPR reduces costs relative to vaccination after US arrival.

• Net cost savings with VPR are $14.7 million per 100,000-refugee cohort and vary from - $44 to $333 per person, depending on the region.

• Vaccination prior to departure reduces the likelihood that refugees would experience illness or costly delays during travel, or arrive while infected with vaccine-preventable diseases such as measles or polio, which may impose additional response costs to mitigate transmission inside the United States.

• Other countries may consider this analysis of potential net cost savings when considering the use of pre-departure vaccination as part of their refugee resettlement program.