A recent study conducted by the Office of Health Economics (OHE, the world’s oldest independent health economics research organization), and funded by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), “reveals that adult vaccination programmes can return up to 19 times their initial investment when the full spectrum of economic and societal benefits is valued. The 19x return is equivalent to up to USD 4637 in net monetary benefits to society per individual full vaccination course.”
“The report has been released ahead of the WHO’s World Immunization Week and is addressing the evidence gaps we identified will be critical in meeting the ambition of the Immunization Agenda 2030,” says the OHE. “This includes a strategic priority to ensure that ‘all people benefit from recommended immunizations throughout the life-course’ and explicitly outlines the need for data guided implementation.”
“We often talk about the value of vaccination for public health,” says Phyllis Arthur, Senior Vice President for Infectious Diseases and Emerging Science Policy at the Biotechnology Innovation Organization (BIO). “This robust study and findings give us a new opportunity to demonstrate overall economic health because of vaccination.”
Vaccines pay for themselves
“We want to be as healthy and productive as possible for as long as possible,” Lotte Steuten, Deputy Chief Executive at OHE, tells Bio.News. “And increasingly, continued vaccinations are one important way to achieve that.”
Vaccination schedules were developed in the early 20th century with the development of vaccines like Smallpox, Diphtheria, Tetanus, and Pertussis (given in combination as DTP), and these schedules were more or less focused on the pediatric space. This made sense as the innovation at the time, as well as the medical need, was highest in the pediatrics space. Today, however, both vaccine innovation and the overall global population have aged and matured.
“Between 2015 and 2050, the proportion of the world’s population over 60 years old is projected to nearly double from 12% to 22%,” observes the OHE white paper. “The global old age dependency ratio (the number of people aged 65+ per 100 people aged 15 to 64) will double from 19 in 2020 to 38 in 2050.”
Yet, social understanding and policy priorities still need to catch up.
“That was one of the reasons we wanted to shine a light on this issue,” Steuten says, “because while many policy decision makers view pediatric vaccines as being incredibly cost effective, there are still some questions as to whether or not that same cost effectiveness holds for true adult vaccinations. And therefore, there is a risk that there will not be enough emphasis on making sure there’s appropriate funding for adult vaccination schedules.”
“There is a misunderstanding of the value of vaccines, versus the cost,” says Steuten. Oftentimes policymakers and politicians (who work on 2-6 year phases) see the initial cost of preventative healthcare measures more so than their long-term value, which spans decades—which risks a penny-smart, pound-foolish policy.
“What we found was that across all disease types,” Steuten says, “vaccines ultimately end up very much paying for themselves as they return so much more value to society than they cost, some do that more than others.
“The broader benefits to society of vaccines are incredibly large, particularly compared to other types of medicines,” Steuten continues. “And quite often, these are completely overlooked. Particularly when we’re thinking about an adult population, these benefits are considerable.”
A broader view of vaccine programs
The OHE research group took a global view, analyzing the vaccine and healthcare data of 10 countries (Australia, Brazil, France, Germany, Italy, Japan, Poland, Russia, Thailand, and the United States). The researchers analyzed large amounts of academic literature and publicly available data.
“We focused on a wide spread of countries from high income to lower-middle income and looked at the value of vaccines there,” says Steuten. “We asked, ‘How common is a disease in a given country?’ And therefore, what are the costs offsets to each kind of healthcare system.”
The researchers were equally as broad in their analysis of different vaccine programs, looking at “four very different diseases that vaccine programs prevent: flu, streptococcus pneumoniae, RSV, and varicella zoster virus (VZV),” explains Steuten, which are very different diseases and vaccines.
“We focused on these different areas because they have a very different impact on people’s health and mortality,” she continues. While flu, pneumococcal, and RSV can be fatal, “shingles is not something you typically die from, so you would expect very different values and returns from these different vaccine schedules across the life spectrum. Additionally, shingles is present in a relatively older population compared to things like flu, so you would expect differences in economic benefit there.”
And within these global community and pathogen spectrums, the researchers broke down their framework into three different areas (looking at both broad and narrow effects within those areas): population health, healthcare systems, and society. And within these value sets, there were more clearly defined value elements, for which there were varying degrees of information for each vaccine program. They did this in order to have a more robust understanding of the cost savings, productivity increases, and improvements in public health.
“Vaccine-preventable diseases continue to produce substantial disease and mortality burdens in adult populations worldwide,” says the report. “Data from the Global Burden of Disease Study shows that 1 in 50 deaths amongst adults aged 20-54, and almost 1 in 25 deaths in adults over 55, were attributable to lower respiratory infections—of which influenza, pneumococcal disease caused by streptococcus pneumoniae, and RSV are the three major causes in adults…These diseases were also responsible for over 1% of the global disease burden amongst 20-54 year olds and 2% of the burden amongst adults over 55.”
It is less understood among general populations that a viral infection can create long-term damage to the body—often people think that once you get better, you are fully recovered. However, the COVID-19 pandemic made the general public start to realize this as long COVID affected many. As the OHE report shows, COVID-19 is not the only infection that can have lasting negative effects, especially as patients get older, and especially with repeat infections.
Vaccines save healthcare systems money
Another area where researchers had more data to work with was the impacts on cost offsets to healthcare systems.
“If you can prevent even one hospitalization, and the cost of that hospitalization is super high, then obviously you’re saving more money,” explains Steuten. Additionally, the standard of care at hospitals improves when countries see higher vaccination rates, both for viral and non-viral diseases. Once again, COVID-19 shined a stark spotlight on hospital strain and its effects on healthcare professionals.
As a 2023 study published in the Journal of Interprofessional Education & Practice found, in Massachusetts, burnout is leading nearly 40% of healthcare workers to plan to leave healthcare within five years—nearly one-third of those under age 35 intending to leave within two years.
“We also compared the cost of that hospitalization in a country where it is expensive to a country where the cost for the same hospitalization is relatively low,” Steuten continues. “As we really dug into the question of how efficient is it really, in terms of what you can gain?”
“There’s a whole host of factors that determine why there are differences between countries, all of which are very hard to pinpoint, but we did consistently find that there is a cost-benefit to vaccines globally,” she notes.
Steuten’s point highlights a key underlying finding in the OHE paper: Vaccines are overwhelmingly good for individuals, societies, and economies, but more information is needed to fully understand their impact on our global community.
A paradigm shift in vaccines
“The paradigm shift happening in the vaccine space is happening as a result of changing demographics,” Steuten says. “Populations in many countries, including the U.S., are aging and policy and decision makers want to understand how to keep people as healthy as possible. Increasingly, vaccinations are an important part of that.”
And with more adult vaccines being developed, policy and healthcare institutions need to create infrastructure to distribute them and meet patients’ needs. Especially because, as the OHE paper observed, the benefits of these programs are unequivocal.
“I think what surprised me the most was that there were positive results across the board,” said Steuten. “Of course, it is easier for researchers to talk about positive results versus negative results, but even in diseases like herpes zoster, the results came out better than expected when it came to increased quality of life.”
And yet, there is still more to understand. Luckily, the information needed is readily available in many countries; we just need to study it and use it.
“To an extent, people may intuitively understand the value of vaccines,” concludes Steuten, “but quantifying that value is still quite a bit of a challenge. There’s still quite a lot of work to be done also in terms of research to make sure we get a better handle on how to measure the broader value of vaccines and have even stronger and more precise estimates on that.”
