Financing & funding
If procuring through UNICEF SD: a box of 100 AD syringes with needles (0.5 ml) is priced at approximately $4.50, equating to $0.045 per syringe with needle; a box of 25 safety boxes (each with a 5-liter capacity) for about $20.26, resulting in approximately $0.81 per safety box. Each 5-liter safety box can hold around 100 syringes, leading to a disposal cost of approximately $0.008 per syringe. Go to footnote 1, Go to footnote 2
Syringe price per dose is estimated to be equal for both the maternal vaccine and the infant mAb. The safety box price per dose is also estimated to be the same between both products. Go to footnote 3 The incremental cost to the healthcare system is estimated to be US$ 0.74 in LICs and US$ 2.02 in MICs. Go to footnote 4
The current price range in HICs for nirsevimab in the public sector varies between US$ 231 and US$ 730 per dose and maternal RSVPreF vaccine ranges between US$ 205 and US$ 234 per dose. In the US the price for the two monoclonal antibodies is the same: US$556 per dose. Go to footnote 5, Go to footnote 6
Pfizer has made a public commitment to develop a multidose vial that will be available in the coming years at a supply and price for the Gavi-eligible market, which is expected to be low and similarly to other vaccines funded by Gavi. Go to footnote 5
PAHO revolving fund has negotiated a price for maternal RSVpreF vaccine for Latin American countries of US$ 49 per dose.
To date, no price commitment for LMICs for monoclonal antibodies has been made. Go to footnote 7
Globally, the estimated cost per person vaccinated ranges between countries. In 2018, the reported cost of delivering a maternal vaccine ranged from US$ 0.55 to $0.64 for LICs, US$ 1.25 to US$ 6.55 for MICs, andUS$ 5.76 to US$ 39.87 in HICs. The UNICEF price estimate for delivering birth dose vaccines (BCG and the HepB vaccines) is US$ 2.34, and this gives an estimate of delivery costs for nirsevimab as a birth dose. Go to footnote 8, Go to footnote 9
In addition to these costs, the direct cost of the vaccines and mAb per dose will need to be included (currently unknown for LMICs).
A study evaluating RSV intervention cost effectiveness in 133 LMICs found that RSV interventions could be cost saving in one-third of countries evaluated and cost-effective in the remaining countries at willingness-to-pay threshold of 0.5 GDP per capita and when the price for the maternal vaccines was US$ 3.50 and the price of the mAb was US$ 3.50. Go to footnote 10
Given lower anticipated prices for maternal RSVpreF, immunization is expected to be more cost-effective than using nirsevimab. Go to footnote 11
Both the maternal vaccines and infant mAbs were approved in the 2018 Gavi Vaccine Investment Strategy. These are to be re-visited at Gavi board in Q4 2025. Only the maternal vaccine has a Gavi price commitment currently and Gavi co-funding and other support is yet to be determined. Go to footnote 12, Go to footnote 13
- Go back to footnote reference 1
UNICEF (2024). Standard costs of fully vaccinating a child. New York: United Nations Children’s Fund (https://www.unicef.org/media/161751/file/Standard%20costs%20of%20fully%20vaccinating%20a%20child_UNICEF_2024.pdf, accessed 20 June 2025).
- Go back to footnote reference 2
UNICEF (2025). AD syringe with needle [website]. New York: United Nations Children’s Fund (https://supply.unicef.org/s0002016.html?utm, accessed 20 June 2025).
- Go back to footnote reference 3
UNICEF (2025). Safety boxes [website]. New York: United Nations Children’s Fund (https://supply.unicef.org/s0782208.html?utm, accessed 20 June 2025).
- Go back to footnote reference 4
Mahmud S, Baral R, Sanderson C, Pecenka C, et al. (2023). Cost-effectiveness of pharmaceutical strategies to prevent respiratory syncytial virus disease in young children: a decision-support model for use in low-income and middle-income countries. BMC Med. 21(1). doi:10.1186/s12916-023-02827-5.
- Go back to footnote reference 5aGo back to footnote reference 5b
World Health Organization (2024). WHO global market study – RSV immunization products. Geneva: World Health Organization (https://cdn.who.int/media/docs/default-source/immunization/mi4a/who_global_market_study_on_rsv_immunization_products_sep-2024.pdf, accessed 20 June 2025).
- Go back to footnote reference 6
Pan American Health Organization (2025). PAHO vaccine prices for 2025. Washington (DC): PAHO (https://www.paho.org/sites/default/files/2025-02/prices-vac-2025-eng-27-feb-25.pdf, accessed 20 June 2025).
- Go back to footnote reference 7
United States Centers for Disease Control and Prevention (2025). CDC vaccine price list for childhood vaccines. Atlanta (GA): US CDC (https://www.cdc.gov/vaccines-for-children/php/awardees/current-cdc-vaccine-price-list.html, accessed 20 June 2025).
- Go back to footnote reference 8
Procter SR, Salman O, Pecenka C, Gonçalves BP, Paul P, Hutubessy R, et al. (2020). A review of the costs of delivering maternal immunisation during pregnancy. Vaccine. 38(40):6199. doi:10.1016/j.vaccine.2020.07.050.
- Go back to footnote reference 9
UNICEF (2024). Costs of fully vaccinating a child. New York: United Nations Children’s Fund (https://www.unicef.org/media/161751/file/Standard%20costs%20of%20fully%20vaccinating%20a%20child_UNICEF_2024.pdf.pdf, accessed 20 June 2025).
- Go back to footnote reference 10
Mahmud S, Baral R, Sanderson C, Pecenka C, Jit M, Li Y, et al. (2023). Cost-effectiveness of pharmaceutical strategies to prevent respiratory syncytial virus disease in young children: a decision-support model for use in low-income and middle-income countries. BMC Med. 21:138. doi:10.1186/s12916-023-02827-5.
- Go back to footnote reference 11
Universal vaccine decision-support model [website]. Geneva: World Health Organization; 2025 (https://sites.google.com/view/univac, accessed 20 June 2025).
- Go back to footnote reference 12
Gavi, the Vaccine Alliance (2018). Report to the Board, 28–29 November 2018: vaccine investment strategy. Geneva: Gavi, the Vaccine Alliance (https://www.gavi.org/sites/default/files/board/minutes/2018/28-nov/docs/08%20-%20Vaccine%20Investment%20Strategy%20document.pdf, accessed 20 June 2025).
- Go back to footnote reference 13
Gavi, the Vaccine Alliance (2025). Gavi welcomes first-ever prequalification of maternal RSV vaccine. Geneva: Gavi, the Vaccine Alliance (https://www.gavi.org/news/media-room/gavi-welcomes-first-ever-prequalification-maternal-rsv-vaccine, accessed 20 June 2025).
