A report from US CDC Morbidity and Mortality Weekly Report (MMWR) in August 2024 explores the health and economic benefits of routine childhood immunisations through the Vaccines for Children Programme (VFC) between 1994 and 2023. The authors assessed and quantified these benefits in both VFC-eligible and non-VFC-eligible children born during this period. They find that childhood immunisations offer “substantial” benefits and promote health equity.
Vaccines for Children Programme
In response to the 1989-1991 measles epidemic in the US, Congress passed the Omnibus Budget Reconciliation Act (OBRA), creating the Vaccines for Children Programme (VFC). This was launched in October 1994 as an entitlement programme for eligible children aged 18 or younger to improve vaccine access. Children can receive vaccines through VFC if they are “Medicaid-eligible, uninsured, underinsured, or American Indian or Alaska Native”. Unpublished CDC data suggest that in 2023 around 54% of children were eligible for VFC vaccines.
VFC has offered vaccines against nine diseases for eligible children aged 6 years or younger since the start of the programme:
- Diphtheria, tetanus, and pertussis
- Haemophilus influenzae type b
- Polio
- Measles, mumps, and rubella (MMR)
- Hepatitis B
Vaccines or immunising agents targeting seven further diseases were added to the schedule for these children between 1996 and 2023:
- Varicella vaccine
- Hepatitis A vaccine
- Pneumococcal conjugate vaccine
- Influenza
- Rotavirus vaccine
- COVID-19 vaccine
- Respiratory syncytial virus (RSV) vaccine
The report
The report examines the health benefits and economic effects of routine childhood immunisation in the US among all children born during 1994 and 2023. The effects of routine childhood vaccination with nine vaccines (DTP/DTaP, Hib, OPV/IPV, MMR, HepB, VAR, HepA, PCV, and Rota) on 30 annual cohorts were evaluated. Influenza and COVID-19 vaccines were excluded from the analysis because the methods for assessing their costs and effects are different from other vaccines.
Net saving and benefit-cost ratios were calculated for the nine vaccines. Benefits were quantified as the savings in direct and indirect costs from averting morbidity and mortality by vaccination. Immunisation programme costs were estimated with CDC Vaccine Price List data and previous research; they comprise the vaccines, administration, parent travel and work time lost, and associated adverse events. Net saving was the sum of the benefits from routine childhood immunisation with the vaccines minus the sum of the programme costs; benefit-cost ratio was calculated as the benefits divided by the immunisation programme costs.
The authors conducted analyses from two perspectives: payer (direct medical and nonmedical costs) and societal (direct and indirect costs). Costs were adjusted to the 2023 US dollar.
Findings
The report states that among around 117 million children born between 1994 and 2023, routine childhood immunisation was estimated to prevent 508 million lifetime cases of illness and 32 million hospitalisations and avert 1,129,000 premature deaths from vaccine-preventable illnesses. The highest estimated cumulative number of hospitalisations and deaths prevented were 13.2 million hospitalisations for measles vaccination and 752,800 deaths for diphtheria vaccination.
Vaccination for these birth cohorts is estimated to “potentially avert” $780 billion in direct costs and $2.9 trillion in societal costs through the prevention of illnesses and deaths. Accounting for $240 billion in direct costs and $268 billion in societal costs of routine childhood immunisation, net savings were $540 billion from the payer perspective and $2.7 trillion from the societal perspective.
“Routine childhood immunisations remain a highly cost-effective public health intervention, preventing thousands of lifetime illnesses, hospitalisations, and deaths.”
Within these benefits, the VFC programme made a “substantial contribution” by purchasing around on half of childhood vaccines at discounted prices. However, the authors emphasise that it is hard to accurately estimate the proportion of benefits attributable to VFC because a child’s eligibility for the programme can change over time. Furthermore, the percentage of vaccines purchased by VFC varies yearly and by vaccine type. Vaccine coverage for “many” of the vaccines was around 90% between 1994 and 2022.
“The VFC programme reduces financial and logistical barriers for eligible children who otherwise might not have reasonable access to immunisation, thereby promoting health equity and contributing sustainably to these high coverage levels.”
The societal costs of routine childhood immunisation over 30 cohorts of children were $268 billion, but the resulting savings were $2.9 million, which means that every $1 spent on childhood immunisations results in savings of around $11. With discounted prices, $1 spent through VFC results in even greater savings.
Comments and implications
The authors acknowledge a coverage decline during the COVID-19 pandemic, which they suggest is partly attributable to “reduced primary care service availability and increases in vaccine hesitancy”. During this time, vaccine-related misinformation and disinformation “affected vaccine confidence” and undermined efforts to achieve high coverage rates. The effects of this can be seen in measles outbreaks.
“VFC plays an important role in maintaining high childhood vaccination coverage by reducing barriers to access, especially in geographic areas and among populations that have historically had lower vaccination coverage.”
The programme and its providers are “critical to facilitating equitable vaccine access” and represents a “critical component” of US preparedness by “supporting important infrastructure needed for distributing medical countermeasures to children” in outbreak settings.
“This analysis demonstrates the continued and substantial health benefits associated with vaccinating young children, rendering the investment in vaccines and immunisations services an important and cost-saving public health strategy.”
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