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The Lifesaving Investment
in Childhood Vaccines

 

Author: Madeline Roberts, PhD, MPH

A recent analysis of the benefit-cost ratios for the Vaccines for Children Program found that the program’s routine childhood vaccines saved an estimated $540 billion in direct costs and $2.7 trillion in societal costs. Vaccines for Children was established by Congress and is a federally funded program which covers child vaccine costs for families that cannot afford them. The analysis reviewed routine child vaccines for children age 6 and under from 1994-2023.

The Vaccines for Children program made a significant public health contribution, with approximately 117 million children receiving vaccines, leading to the prevention of an estimated 508 million illnesses, 32 million hospitalizations, and 1,129,000 deaths. This widespread immunization effort resulted in substantial economic savings. From a payer standpoint, there was an estimated savings of $540 billion in direct medical and non-medical costs, such as the cost of treating initial infections. There was an additional estimated savings of $2.7 trillion in societal costs, which includes productivity losses from premature death and disability, and also opportunity costs for parent work absences attributable to caring for their sick children. 

This analysis also highlights The Vaccines for Children program's role in maintaining high vaccination coverage and promoting health equity, emphasizing the program’s importance in reducing barriers to access for vulnerable populations.

The report underscores the cost-effectiveness of routine childhood immunizations, revealing that for every dollar spent, society saves approximately $11. Although the analysis excludes certain vaccines like influenza and COVID-19, it demonstrates that immunization remains a crucial public health intervention. The VFC program, by covering nearly half of the nation's childhood vaccines at discounted prices, has made a substantial impact, particularly during challenges like the COVID-19 pandemic. Despite some limitations, the findings strongly support the continued investment in childhood immunization as a vital strategy for improving public health and ensuring long-term economic savings.

Unfortunately, the WHO recently reported that childhood vaccination rates stagnated globally in 2023. In 2023, the global childhood vaccination rate for measles was 83% for an initial dose and 74% for a second dose, neither of which reaches the 95% threshold for outbreak prevention. More concerning, the number of “zero-dose” children (those not receiving even a single dose) for the diphtheria, tetanus and pertussis (DTP) vaccine increased in 2023; the number of children receiving three doses remained stagnant.

The majority of children not receiving vaccines live in vulnerable areas or areas of active conflict, and the WHO cited “ongoing challenges with disruptions in healthcare services, logistical challenges, vaccine hesitancy and inequities in access to services” as contributing factors to globally stagnant vaccine uptake.

The United States was declared measles-free in 2000, but routine measles vaccination rates began to languish around 2010, which paved the way for more frequent outbreaks in recent years. This has been of great concern to epidemiologists and public health workers, and is perhaps best captured by this quote from WHO Director-General Dr Tedros Adhanom Ghebreyesus: “Measles outbreaks are the canary in the coalmine, exposing and exploiting gaps in immunization and hitting the most vulnerable first. This is a solvable problem. Measles vaccine is cheap and can be delivered even in the most difficult places.” As an example of this, a multi-country study found that underweight and stunting were associated with incomplete vaccination schedules.

Similarly, a underweight and stunting were associated with incomplete vaccination schedules. Similarly, a 2022 study of the association between nutritional status and full vaccination coverage in Thai children under age 5 found that children with incomplete immunization status had higher odds of being stunted, wasted, or overweight.  

The CDC created VaxView, an interactive data visualization tool to assess various measures of vaccination coverage across the country. For example, below is a map showing U.S. vaccination coverage for children receiving one or more doses of the MMR vaccine for children born in 2020.

If decreased vaccination coverage is the blinking light on the dash, an initial indicator of potential failure, there are multiple public health issues that may be signaling: vaccine hesitancy fueled by misinformation, which weakens trust in public health and science; scientific communication and education gaps; inequities in healthcare access, particularly in marginalized communities. The Vaccines for Children Program has demonstrated remarkable health and economic benefits, underscoring the critical role of routine childhood immunizations in public health. However, the stagnation in global vaccination rates and the resurgence of diseases like measles highlight the vulnerabilities in immunization delivery, particularly in underserved populations. These trends serve as a warning of potential public health crises if vaccine coverage continues to decline. Ensuring sustained investment in vaccination programs and addressing barriers to access are essential to prevent the erosion of these hard-won gains and to protect future generations.

 

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