Nguyen Khanh Phuong, Ong The Due, Zhang Xinyu, Do Tra My, Do Thi Quynh Trang, Tang Shenglan
Health Strategy and Policy Institute, Ministry of Health, Hanoi, Vietnam.
Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China.
Lancet Reg Health West Pac. 2025 Aug 4;61:101648. doi: 10.1016/j.lanwpc.2025.101648. eCollection 2025 Aug.
Ensuring sufficient financial resources for improving effective and efficient procurement of vaccines was highlighted by the Immunization Agenda 2030, which is particularly challenging for middle-income countries (MICs) that are ineligible for support from Gavi, the Vaccine Alliance. In response to the broader decentralization of the governance system and decreased international development aid, the central government of Vietnam decentralized the responsibility of financing the Expanded Program on Immunization (EPI) to provincial governments in 2023 but rapidly reversed it considering its following negative consequences, for example, severe vaccine stockouts and the largest decline in childhood immunization coverage in over 20 years. This paper analyzed the consequences closely linked to decentralization in Vietnam, the underlying reasons, and lessons for other MICs. To avoid recurrence, MICs should ensure the primary role of the central government in EPI financing and management, improve the local management capacity, and allocate more resources toward less-developed areas to narrow the intra-country disparities.
《2030年免疫议程》强调要确保有足够的财政资源来改善疫苗采购的有效性和效率，这对那些没有资格获得疫苗免疫全球联盟（Gavi）支持的中等收入国家（MICs）来说尤其具有挑战性。由于治理体系的广泛分权以及国际发展援助的减少，越南中央政府于2023年将扩大免疫规划（EPI）的融资责任下放给省级政府，但考虑到随之而来的负面后果，例如严重的疫苗短缺以及20多年来儿童免疫覆盖率的最大降幅，很快又推翻了这一决定。本文分析了越南分权带来的紧密相关后果、根本原因以及对其他中等收入国家的教训。为避免再次发生，中等收入国家应确保中央政府在扩大免疫规划融资和管理中的首要作用，提高地方管理能力，并向欠发达地区分配更多资源以缩小国内差距。
