Experts: Many pitfalls in putting a price tag on the value of vaccinations

Photo by Sanofi Pasteur

While the medical importance of vaccines is largely known, a pair of researchers is looking to define just what economic value vaccines play in the realm of global healthcare.

In a recent study published in Health Affairs, authors Jason Schwartz and Adel Mahmoud, said understanding the economic impact of vaccines is now an easy task, considering the "shared belief in the inadequacy of most current methods of measuring value, which largely concentrate on health and economic benefits directly related to the prevention of disease in vaccinated individuals."

In order to more fully determine the value of vaccinations, the authors suggest considering factors such as "increased productivity later in life following vaccination, improved cognitive and educational outcomes, community-level health gains through herd effects, and vaccination-related benefits to macroeconomic factors and even political stability."

Most analysts, health systems and policymakers acknowledge that there's an economic benefit to the research and development of various types of vaccinations -- from the healthcare costs avoided by preventing illnesses to the increase in productivity of caregivers.

There are other issues at play, however. Schwartz and Mahmoud recommend including social, moral and ethical considerations when determining the fiscal impact of vaccinations. That includes examining how vaccination programs can help to promote equity and social justice, further encourage society to show concern for its most vulnerable members, and promote goodwill and trust among world countries.

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Determining the specific role of those can be difficult, they said, which is why those additional benefits have been overlooked when examining total economic impact. The authors  suggest applying the social, moral and "deeper view" considerations not just to vaccination programs, but to apply the same model consistently across other prevention initiatives.

That, they say, would level the playing field and prevent "vaccination exceptionalism."

Another potential trap identified by Schwartz and Mahmoud is the inclination to view vaccination in isolation -- to pit it against other health initiatives in competition for increasingly scant resources.

Vaccination activities can both contribute to and benefit from well-functioning health systems, they said.

"The Ebola outbreak centered in West Africa underscored the need to think broadly about the role of vaccines," they said. "Vaccination is best positioned to thrive if it is seamlessly integrated within larger efforts to prevent disease and improve health, an integration that admittedly complicates efforts to isolate and measure the economic benefits brought specifically by vaccination programs."

With respect to the social and ethical considerations, the relationships between vaccination and other activities can be complex.

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"To be sure, vaccination efforts can promote equity across communities and generations as well as greater trust in health officials, but the very success of those activities depends on a foundation of public confidence in government, health officials, and health workers," the authors said. "Attacks on health workers participating in polio eradication efforts tragically highlight the consequences of these important considerations."

The complexity of those relationships can add to the challenge in determining "the degree to which vaccination programs are an engine to promote social and ethical imperatives or a beneficiary of general efforts in those areas."

Finally, the inclination to try to quantify vaccination factors can be a trap because it can lead to arbitrary or inconsistent policy decisions as they seek to place "softer arguments" (such as the social and ethical benefits of vaccination) in the same league as more straightforward cost/benefit analyses.

"Policymakers and others tasked with translating evidence into policy would be best served by remaining vigilant in seeking to identify and critically assess the judgments embedded in any argument regarding the value of vaccination or that of any potential investment priority," said Schwartz and Mahmoud.

They claim that these difficulties in determining the value of vaccinations should not be an impediment; rather, it's necessary to understand the challenges in order to overcome them.

The solution, they said, is investment -- particularly when it comes to understanding how policy makers and their advisers analyze data and craft concrete policy proposals.

"This work can lead to a clearer understanding of the needs of these groups when evaluating the value of vaccination or other potential investments," they claim. "It can also facilitate the development of best practices that can be shared among national and international bodies."

There's already some encouraging work being done in this area, notably by expert panels that advise governments on the design of national immunization programs. Their only shortcoming, said Schwartz and Mahmoud, is that their focus on vaccination programs is narrow and doesn't take into account any competing priorities.

A fuller, broader view would benefit rich and poor nations alike, they said.

"It offers the potential for greater government attention to and enthusiasm for vaccination, broader public support for vaccination programs, and increased private investment in vaccine research and development," Schwartz and Mahmoud said. 

Twitter: @JELagasse