PROGRAM ON THE GLOBAL DEMOGRAPHY OF AGING Working Paper Series The Economic Case for Expanding Vaccination Coverage of Children

While childhood vaccination programs, such as WHO’s Expanded Program on Immunization, have had a dramatic impact on child morbidity and mortality worldwide, lack of coverage with several existing vaccines is responsible for large numbers of child deaths each year, mostly in developing countries. According to WHO estimates, increased coverage of three vaccines alone – pneumococcal conjugate vaccine (PCV), rotavirus vaccine (Rota), and Haemophilus influenzae type b (Hib) vaccine – could have prevented one and a half million deaths in children under five years in 2002. In deciding whether to implement interventions to expand vaccination coverage policy makers often consider economic evaluations. Past evaluations, however, have usually ignored both important vaccination benefits and potentially large cost reductions in vaccination delivery. We demonstrate for the example of benefit-cost analysis (BCA) of the Hib vaccination that past studies have mostly taken narrow evaluation perspectives, focusing on health gains, health care cost savings, and reductions in the time costs that parents incur when taking care of sick children, while ignoring other benefits, in particular, outcome-related productivity gains (Hib vaccination can prevent permanent mental and physical disabilities) behavior-related productivity gains (reductions in child mortality due to Hib can trigger changes in fertility which in turn may stimulate economic growth) and community externalities (Hib vaccination can prevent the development of antibiotic resistance and reduce the risk of Hib infections in unvaccinated persons). We further show that the costs of Hib vaccine delivery can be reduced if the monovalent Hib vaccine is replaced by combination vaccines. Such cost reductions have usually been ignored in CBA of Hib. Our analysis thus suggests that past BCAs are likely to have substantially underestimated the value of Hib vaccination, even though most have found it to be cost-beneficial. Unless future BCAs of childhood vaccinations take full account of benefits and costs, policy makers may lack sufficient information to make the right decisions on vaccination interventions.