In finance, one hears the term “return on investment” frequently. A more colloquial expression might be “bang for the buck”. Another angle in the same discussion, especially when discussing the healthcare system, would be for a patient to reduce negative behavior and increase positive behavior. Examples of these behaviors might be to reduce “high risk” intimate encounters but increase exercise. Both of these modifications of behavior would have a positive outcome, i.e. improvement of one’s health and reduction of treatment costs.
Currently, there are a number of vaccines available to prevent infections, including (not exhaustively) those for Covid-19, DTaP, hep. A, hep. B, Hib, HPV, influenza/flu, meningococcal, MMR, Polio, RSV, Tdap/Td, varicella/chickenpox/shingles, etc. 2 of the above vaccines, hepatitis B and HPV, also prevent cancer. These tools, when used properly, are incredibly important to preserve and protect health as well as reduce costs to the system.
As an example, the Journal of Medical Economics published Economic Value of Vaccines to Address the Covid-19 Pandemic: a US Cost-Effectiveness and Budget Impact Analysis by Padula et al. in 2021. This analysis used one of this author’s favorite techniques, Markovian analysis. In summary, their analysis indicated that a vaccine based intervention to prevent Covid-19 would reduce costs to society by “80% or more” in this case, tens of billions of dollars. Not discussed in this analysis were parallel costs to society when caretakers had to reduce work hours to assist in care for the patients and even time off for bereavement if the patient passed away(!).
Although listed above are over a dozen illnesses for which there are effective vaccinations, it is worth reviewing 1 of the great successes in medical history, the vaccines for polio. Polio is itself a virus that affects the nerves to muscles. The weakened nerves caused paralysis of the muscles including on occasion the diaphragm. The diaphragm is that muscle that allows us to breathe. So polio victims would often suffocate. In the middle of the last century, at the apex of its incidence, polio was contracted by more than 50,000 Americans which ultimately forced up to 1000 people at a time into the so-called “iron lungs” (mid-century ventilation machines) to take over the mechanics of breathing for the patient. Absent the iron lung, a patient would suffocate in minutes. The patient needed this machine every moment of the day, 24 hours/day, every day the year. Many of these patients had severe weakness of all their muscles and needed a caretaker the majority of the day. With the Salk and Sabin polio vaccines, the cases in the United States dropped from a peak of approximately 50,000 per year to <10 per year just over 60 years ago. The author of this article considers that close to a miracle. Again, note that this is just 1 of multiple successful vaccines.
Based on available information, childhood vaccination rates hover between 80 and 90%. Vaccination rates for adults are often lower. As one example (of many), adult ages 19-64 had only 23% incidence of pneumococcal vaccination. Because many millions of people are not properly vaccinated for all targeted diseases in the United States, one might reasonably extrapolate from the Covid-19 data above that if we were all properly vaccinated for all recommended diseases, the medical cost savings alone would be hundreds of billions of dollars per year. This is very important to emphasize because we live in an age in which medically and scientifically unsophisticated individuals are making claims that cannot be substantiated by fact regarding vaccinations. Floating in the background of rigorously established data regarding vaccines are vacuous claims about vaccine related danger. One way to address this would be to have the medical system pay for all approved vaccines. If, subsequently, a vaccinated individuals suffer significant side effects, treatment would be paid for by the medical system. If, on the other hand, a patient declines a vaccine and then subsequently develops the targeted illness, the patient should be responsible for all treatment costs. Unless an individual has deep pockets, most would be compelled to accept the standard of care.
As noted at the top of this article, one might at this point ask what is the return on investment for vaccines. The answer is objectively that it’s huge. On 8/8/24, authors Zhou et al. published the article Health and Economic Benefits of Routine Childhood Immunizations in the Era of the Vaccines for Children Program — United States, 1994–2023 in the Morbidity and Mortality Weekly Report. The article calculates that for every $1 spent on childhood immunizations, $11 are saved. Put another way, there is a financial savings of 1000%. This study reviewed cost, morbidity, and mortality for children (in this case, not adults) but indicated that 38,000 children would have died unnecessarily and hundreds of thousands more would have become quite ill had it not been for their undergoing vaccinations. There is no immediately available cost estimate for adults but I suspect that the return on investment would be at least as great for adults as the young ones.
In the above, Covid-19 vaccinations alone (of multiple vaccine choices) would save tens of billions of dollars per year alone with proper vaccination rates. Certain diseases, such as polio, still exist in the world and may well reactivate affecting tens of thousands of Americans per year who, once more, would suffer paralysis. If the paralysis were great enough, the patient would stop breathing and require a tracheostomy and external ventilation for the remaining years/decades of the patient’s life. Also mentioned above was that for every $1 invested in vaccinations, one would save $11 by preventing diseases (at least in children).
As a final observation, the acceptance of vaccine science is not a given in the United States as of late. A subset of religious groups has always had some hesitancy regarding vaccines. However, there is now also a growing number of nonclinical skeptics balking at the efficacy, necessity, and safety of vaccines whose conclusions on the matter seem completely untethered to scientific realities. Our policymakers and leaders must find the fortitude to follow the science, not the herd.