Expanding Vaccination Coverage Challenge

The Challenge

Vaccination may be the most effective public health intervention of all time. But incomplete vaccination coverage is responsible for large numbers of preventable child deaths every year. According to UNICEF, a quarter of the world’s children – about 26 million infants – are not immunized against the worst diseases.

The three vaccine-preventable diseases responsible for the most child deaths are pneumococcal disease, rotavirus infection, and Hib infection.

Pneumococcal disease and Hib infection (or Haemophilus influenza type b) are both serious diseases and are caused by bacteria which can attack different parts of the body. In the lungs, infection can cause bacterial pneumonia; in the bloodstream it can cause bacteremia; in the brain it can cause meningitis. Either disease can cause death or leave a child with severe neurological conditions such as deafness, blindness, or intellectual impairment.

Rotavirus infection is a viral infection of the intestine, and can cause fever, vomiting, and severe diarrhea. It spreads very easily from one child to another. It can cause malnutrition, leaving lasting impacts on a child’s life.

The Solution

Vaccination is the most effective way of protecting children against pneumococcal disease, Hib infection and Rotavirus infection.

When the World Health Organization’s Expanded Program on Immunization was launched in 1974, less than 5% of the world’s children were immunized during their first year of life against major killer diseases. The program helped countries establish the infrastructure needed to introduce and deliver a standard vaccine package. Now, nearly 79% of children receive life-saving vaccinations. However, coverage is widely incomplete.

The Research

Decision-makers commonly use a cost-effectiveness test when they decide whether to finance a health-care initiative.

In ‘The Economic Case for Expanding Vaccination Coverage of Children’, a Best Practice Paper for the Copenhagen Consensus Center, David Bloom et al. argue that these economic evaluations have traditionally been too narrow. They write that decision-makers traditionally consider only some categories of vaccine effects, while disregarding others, and fail to take into account changes in vaccine costs that can be achieved by combining several vaccines into a single delivery system.

The authors argue that this narrow perspective could mean that the benefits of vaccination have been underestimated, the costs have been overestimated, and the wrong decisions made on whether to finance vaccination.

Bloom et al. use the Hib vaccine as an example to outline this case. The vaccine has been introduced into national vaccination schedules in most countries worldwide, but with global coverage of just 26%, it has the lowest coverage of all of the World Health Organization’s Expanded Program on Immunization vaccines.

When vaccines can be combined and provided together, costs are dramatically reduced. This has not factored in traditional cost-effectiveness studies. Unlike vaccines against pneumococcal disease and rotavirus infection, the Hib vaccine can be combined with the DTP vaccine (which protects against diphtheria, tetanus, and pertussis) and delivered in a single injection. The combined DTP and Hib vaccination could prevent 703,000 deaths annually.

Economic analyses of the benefits and costs of vaccination programs usually focus on health improvements, reductions in health care costs, and the reduced time parents must spend taking care of sick children. Bloom et al. argue that this offers an incomplete understanding of vaccine-related benefits.

They point out that children who are healthy are more likely to attend school and to attain high education levels; adults who are physically healthy and well educated can work more and more productively.

Vaccination effects can also change behavior. For instance, in areas with many child deaths, couples may choose to have more children so that enough offspring survive to support the family. As Hib vaccination reduces the level of child deaths, parents have fewer children and ‘invest’ more in each child, improving the results in nutrition, health and education. These improvements, in turn, will see a child become a more productive adult.

There are also the so-called ‘herd effects’ – the reduction in an unvaccinated person’s risk of contracting a disease due to the vaccination of another person.

Many bacterial infections, including Hib infection, are treated using antibiotics. Vaccinations can therefore reduce the level of antibiotic resistance, saving governments, medical institutions, and communities money that would otherwise have been spent on treating antibiotic resistant strains of illnesses.

Understanding the links between vaccination programs, health, education, and labor productivity has implications for all vaccines, not just the Hib vaccine.

It is important to draw attention to the non-health benefits of vaccination, including effects on educational attainment and labor productivity. Only when all benefits of vaccinations for the health, education, and economy of a country are considered simultaneously with the cost of vaccine delivery will policy makers have sufficient information to take the right decisions on expanding vaccination programs.

Where to Find Out More

The Copenhagen Consensus research that this section draws from:

The Economic Case for Expanding Vaccination Coverage of Children: Best Practice Paper
Till Bärnighausen, D.E. Bloom, D. Canning, A. Friedman, O. Levine, J. O’Brien, L. Privor-Dumm, D. Walker

Disease Control: Copenhagen Consensus 2008 Assessment Paper
Dean Jamison, P. Jha, D.E. Bloom

Disease Control Chapter
in Global Crises, Global Solutions second edition
edited by Bjorn Lomborg

The Expert Panel's individual rankings and further elaboration can be found in the book, Global Crises, Global Solutions, second edition.