A Milliliter of Cure: How Investment in Vaccine Provision Could Yield Substantial Economic Returns

One of the more prominent global health initiatives in recent years has involved increasing vaccination rates worldwide, particularly in developing countries. Advocates for increased vaccine coverage argue that vaccinations can help achieve Millennium Development Goals (MDG) by decreasing child mortality. Large foundations like the Bill and Melinda Gates Foundation and the GAVI Alliance have also increased activity surrounding vaccine provision.

Partially in response to growing international attention, the World Health Organization in 2012 passed the Global Vaccine Action Plan (GVAP). The GVAP calls for between $50 and $60 billion in investment through 2020 to improve vaccination rates for existing vaccines (e.g. polio, tetanus, measles) and to develop new vaccines where possible. The plan is ambitious in both size and scope, and policymakers are interested in assessing the value of such investments. In particular, they are interested in seeing whether improving vaccination rates translates into long-run economic growth through increases in productivity, time spent working, and school attendance. While advocates have touted the benefits of vaccine investment for many years, few studies have sought to quantify the return on investment (ROI) that countries can expect from spending.

In a recent study published in Health Affairs, Sachiko Ozawa and colleagues seek to estimate the ROI from reaching the desired vaccination level in a set of low- and middle-income countries. The authors focus specifically on the effects of vaccinating for diseases caused by ten common antigens: Haemophilus influenzae type b, hepatitis B, human papillomavirus, Japanese encephalitis, measles, Neisseria meningitidis serogroup A, rotavirus, rubella, Streptococcus pneumoniae, and yellow fever.

The researchers consider economic impacts on two main levels. First, they want to think about the specific effects that vaccinations have on reducing the costs of disease. These include the costs of treating the disease, the transportation required to receive care, lost income if a caregiver has to take care of a sick individual, and lost productivity when someone is falling ill. Second, the authors are interested in the broader effects that vaccinations may have on “full income,” which includes not only wages but also the additional benefit associated with living a longer and healthier life. The authors collect data on these measures for 94 low- to middle-income countries worldwide, and calculate the ROI by dividing net benefits (full economic benefits minus costs) by the costs of the program.

The authors find that vaccine provisions are associated with substantial positive economic impacts, both in terms of reducing disease costs and increasing “full income.” An investment that achieves the desired level of vaccination by 2020 is estimated to yield reductions in the costs of disease 16 times greater than initial cost. Further, when they look at the effect on “full income,” researchers expect the vaccine investment to yield returns 44 times greater than initial cost. Ozawa and colleagues find that ROI is highest for measles vaccines, with returns of nearly 60 times its cost, followed by smaller yields for yellow fever and Haemophilus influenzae type b. Additionally, the net benefits associated with investment are highest in Sub-Saharan Africa ($224 billion) and Southeast Asia ($207 billion).

The authors are careful to note in their analyses that these ROI estimates compare desired vaccination levels to no vaccination at all, so the results should not be interpreted as the effect of scaling up existing programs or adding incremental vaccines over time. Even after taking this into account, their analyses present evidence that investing in vaccines could have a significant impact on economic growth and development in low- and middle-income countries. Through a concerted and coordinated effort to invest in vaccinations going forward, significant progress could be made toward achieving Millennium Development Goals and alleviating economic disparities.

Article Source: Ozawa, Sachiko, Samantha Clark, Allison Portnoy, Simrun Grewal, Logan Brenzel, and Damian G. Walker. “Return on Investment from Childhood Immunization in Low- and Middle-Income Countries, 2011–20,” Health Affairs, 35(2): 2016.

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