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Immunisation is one of the most cost-effective ways to save lives, improve health and ensure long-term prosperity

New data confirms immunisation as best buy in public health
Johns Hopkins University study shows 16-fold return on investment in immunisation from 2011 to 2020.
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Public health's 'best buy'

Immunising children is one of public health's "best buys". Vaccines are relatively easy to deliver and, in most cases, provide lifelong protection. They boost development both through direct medical savings and indirect economic benefits such as cognitive development, educational attainment, labour productivity, income, savings and investment.

A 2016 study conducted by Johns Hopkins University and published in Health Affairs1 found that for every dollar invested in vaccination in the world’s 94 lowest-income countries, US$ 16 are expected to be saved in healthcare costs, lost wages and lost productivity due to illness and death. Focusing on Gavi-supported countries only, this figure rises to US$ 18.

If we include broader benefits, such as the value that people place on living healthier, longer lives and the long-term burden of disability, the net return increases to US$ 44 per dollar invested. Looking only at Gavi-supported countries this figure again rises, this time to US$ 48. This brings the overall economic benefit for the 2011–2020 period – the “Decade of Vaccines” – to more than US$ 1.5 trillion.

According to David Bloom, Professor of Economics and Demography at Harvard University, “the return on investment for many vaccines appears, conservatively, to be at least as high as the return on investment for spending on primary education.”2  

Although new vaccines supported by Gavi cost more than other vaccines that have long been included in national immunisation programmes, they remain cost-effective compared with many other interventions:

Hepatitis B

A review of economic evaluations found that universal immunisation against hepatitis B in intermediate and high-endemic countries is cost-effective or even cost-saving in comparison to no vaccination.3  

Hib and pneumococcal

The majority of economic evaluations of Haemophilus influenzae type b vaccines conclude that the vaccine is a cost-effective intervention.4 It is estimated that pneumococcal vaccines are highly cost-effective in the vast majority of Gavi-supported countries.5  


According to a 2009 study, at an initial price of US$ 7 per dose, which gradually decreases over time to US$ 1.25 per dose by 2017, vaccination with rotavirus vaccines would be very cost-effective in all Gavi-eligible countries.6  


A 2016 review published in the Lancet showed that HPV vaccination is very cost effective in low- and middle-income countries, assuming high vaccine efficacy and a long-lasting effect.7  


The cost-effectiveness of immunisation has made vaccines increasingly affordable for low-income countries. While all low-income countries are largely dependent on external support to finance vaccination, domestic investment in immunisation is rising. In Gavi-supported countries, the average country investment in vaccine per child increased from US$ 3.80 in 2010 to US$ 5.09 in 2015.

1 Ozawa S, Clark S, Portnoy A, Grewal S, Brenzel L, Walker D.G. Return on investment from childhood immunization in low- and middle-income countries, 2011-20. Health Affairs. 2016 Feb;35(2): 199–207

2 Gavi, the Vaccine Alliance. Gavi mid-term review report. 2013.

3 Tu HT, Woerdenbag HJ, Kane S, Riewpaiboon A, van Hulst M, Postma MJ. Economic evaluations of hepatitis B vaccination for developing countries. Expert Rev Vaccines. 2009 Jul;8(7):907-20.

4 Griffiths UK, Miners A. Economic evaluations of Haemophilus influenzae type b vaccine: systematic review of the literature. Expert Review Pharmacoecon Outcomes Res. 2009 Aug;9(4):333-46

5 Tasslimi A, Nakamura M, Levine O, Knoll M.D, Russell L, Anushua S. Cost-effectiveness of child pneumococcal conjugate vaccination in Gavi-eligible countries. International Health. 2011 Dec;3(4):259-69

6 Atherly D, Dreibelbis R, Parashar UD, Levin C, Wecker J, Rheingans RD. Rotavirus vaccination: cost-effectiveness and impact on child mortality in developing countries. J Infect Dis. 2009 Nov;200(Supp 1):S28-38

7 Denny L, de Sanhose S, Mutebi M, Anderson B.O, Kim J. Interventions to close the divide for women with breast and cervical cancer between low-income and middle-income countries and high-income countries. 2016 Nov. S0140-6736(16)31795-0 (published online).

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