Cost of mass vaccination against H1N1 influenza: A comparison of two New York City campaigns

Background: In fall 2009, the New York City Department of Health and Mental Hygiene (DOHMH) launched one of the nation's largest efforts – including a school-located campaign and a community-based Point of Dispensing (POD) campaign – to deliver influenza A (H1N1) 2009 monovalent vaccine. The objective of this study was to estimate and compare total campaign costs and costs per dose.

Methods: Expenses including personnel, supplies/equipment, logistics and overhead were calculated in 2009-2010 U.S. dollars from DOHMH's perspective. Costs were obtained from invoices or estimates of expended resources. Vaccination data were obtained from the Citywide Immunization Registry and POD reports. Maximum capacity was estimated by applying the number of doses administered at high performing sites to all schools and PODs.

Results: The school-located campaign delivered an estimated 240,205 vaccines at a cost of $17.6 million and cost per dose of $73. PODs delivered 49,986 vaccines at a cost of $7.5 million and cost per dose of $150. At projected maximum capacity, the school-located campaign could have delivered 312,616 doses at $59 each, and PODs could have administered 174,000 doses at $50 each.

Conclusions: Successful implementation of both campaigns required significant resources. As conducted, the school-located campaign delivered vaccines at a lower cost per dose than PODs and was particularly effective at reaching children. With higher demand, both campaigns may have delivered vaccine at lower, more comparable costs per dose; they should both be considered as effective strategies for increasing vaccination coverage during future emergencies.