The benefits of vaccination to individuals are well known: vaccines help to protect us against infectious diseases. This has positive knock-on effects for health systems by reducing the number of people needing medical care and hospitalization.
However, a leading Harvard health economist argues for a broader view of the societal benefit of immunization programmes, incorporating non-health benefits such as educational attainment, as well as individuals’ contribution to family and community.
Professor David Bloom believes the value of vaccines is coming into view as governments and health authorities grapple with one of the biggest public health challenge of our generation: Antimicrobial resistance (AMR).
‘AMR is the dark cloud on the horizon,’ he told Vaccines Today. ‘The health, economic and societal threat this poses are enormous. Vaccines can slow the pace at which drug resistance develops by reducing cases of disease and thereby limiting the use and misuse of antibiotics.’
Prof Bloom said an estimated 1% of global deaths are attributed to AMR and this is projected to rise sharply. In the EU, experts now estimate that around 33,000 people die from AMR-related illnesses, according to new figures released ahead of European Antibiotics Awareness Day (18 November).
In assessing the economic impact of AMR, Prof Bloom points to the burden of suffering longer and more progressive episodes of disease.
‘It can take time, and additional costs, if patients need 2nd or 3rd line antibiotics,’ he explains. ‘These drugs are more expensive and can have worse side effectives. On top of that, the risk of hospital-acquired infection could eventually lead people to forego elective surgery – perhaps avoiding a hip replacement, for example. A substantial value of vaccines is their capacity to help tackle this problem.’
Wanted: more data, better models
However, experts say that while AMR is an enormous challenge and vaccines play a role in overcoming the problem, more work is needed to calculate the precise economic contribution of immunization in this area.
‘Modelling the complex relationships in the AMR equation involves collaboration between three groups – those modelling antibiotic stewardship, vaccination modellers and those modelling health and economic outcomes,’ according to Dr Charles Clift, at the Centre on Global Health Security, Chatham House, a think tank. ‘Estimating the value of vaccination in preventing AMR will require integration of approaches used by the vaccine modelling, AMR modelling and economic evaluation communities.’
This was echoed in a paper by UK-based health economists, and by a UK Parliament briefing which said existing economic models must be enhanced in order to capture fully the link between vaccination and AMR.
Prevention is cheaper than cure
This line of thinking fits a broader trend in health economics towards weighing the societal value of vaccines. Bloom and others believe that preventative health measures, including vaccination, are undervalued.
Commonly-overlooked benefits of immunization include gains in productivity and the higher incomes of healthier people, as well as reductions in health and economic insecurity, and greater social equity, he argues.
‘For example, working adults benefit from vaccination through the reduction in lost days of work due to sickness or caring for sick relatives,’ according to Prof Bloom. ‘Lost days at work not only correspond to reduced income for the individual, they also translate into decreased opportunity for taxation and decreased productivity in society.’
Broader benefits
The benefits of investing in education have been well established through the second half of the 20th century, prompting governments and international agencies such as the World Bank to invest in schools. Now economists are taking a similar approach to make the case for investing in preventative health.
For younger people, staying healthy can improve school attendance, classroom performance and ultimately improve earning capacity in later life. ‘Healthy kids miss less school and do better in school,’ Prof Bloom says. ‘Cognitive function is better; they get more out of every school day. And they avoid long-term physical disability that can come with some infectious diseases. All of this feeds into expected higher productivity and higher earnings.’
The economic benefits of vaccination are not only seen in children. Vaccinating adults with chronic conditions such as COPD, diabetes or heart failure can keep them well, preserve productivity and avoid spending on treating complications of non-communicable disease.
‘For example, a recent study of the benefits that would follow from providing the 13-valent pneumococcal vaccine to older adults in Denmark indicates a rate of return of over 150%. For diabetics aged 65 and over, the rate of return would be over 1200%,’ says Prof Bloom.
He says this kind of economic thinking is already well-established in estimating the value of public spending on infrastructure (e.g. roads, high-speed broadband) which underpin societal and economic progress. Health is playing catch-up.
‘Healthier means wealthier – that idea has been around for a couple of decades, but we are now beginning to gather the evidence that shows the full economic and social benefits of vaccination.’
