In late November, news of Omicron, the latest SARS-CoV-2 variant of concern, emerged. The response was grimly predictable. New travel restrictions went into effect within hours; the global financial markets heaved; and the finger pointing began.
The development once again laid bare the consequences of a highly transmissible infectious disease. “We have a pathogen that emerged as a health issue and within three months or less brought the whole global economy to a halt,” says Muhammad Pate, a Harvard University public health expert and former Global Director for Health, Nutrition, and Population at the World Bank.
Beyond the obvious threats to individual health and well-being, unchecked infectious diseases bring extraordinary economic and social risks. Vaccines are perhaps one of the most potent tools to preserve economic stability and quality of life. Yet their development and distribution globally are often not prioritized.
In the case of SARS-CoV-2, significant disparities exist in vaccine availability between wealthy and low- and middle-income countries (LMICs), leaving billions unprotected and economic recovery uncertain. In nations with significant vaccine supplies, hesitancy or complacency has set in, tamping down vaccination rates and prolonging the pandemic.
The reasons for this are complex and varied, but one cause often goes unmentioned: Vaccines and vaccine development are chronically undervalued. Vaccines are, of course, a means to limit hospitalizations and death, but that is a narrow view. Mark Jit, an epidemiologist at the London School of Hygiene and Tropical Medicine, says, “We need to think of health as a means to development as well.”
A question of value
When considering vaccines, value can be ascribed in a number of ways. “The typical metrics just look at the direct health impacts and also maybe if there are some healthcare cost savings,” says Maddalena Ferranna, a research associate at the Harvard School of Public Health. But measures such as hospitalizations, deaths and healthcare costs understate the full impact of novel and highly transmissible infectious disease.
Beyond the lockdowns, travel bans and job losses associated with vaccine-preventable diseases, such as seasonal influenza, cause work absences, increase childcare demands and reduce productivity. By reducing disease transmission, vaccines can prevent such consequences, but these benefits go nearly unrecognized in most assessments of a vaccine’s value. “It’s not just about how many lives it saves,” Jit says. “It’s about how this is going to transform the economies of countries around the world and contribute to global economic growth and health security.”
Undervaluing vaccines restricts investment in their research, development and distribution. This in turn reduces global pandemic preparedness and leaves billions, particularly in LMICs, vulnerable to vaccine-preventable diseases.
Few cases illustrate this point better than the COVID-19 Vaccines Global Access (COVAX) public-private partnership, which was designed to facilitate equitable vaccine distribution early in the pandemic. The critical work of COVAX was stymied by delayed decisions in investments and a lack of adequate funding. At the same time, many wealthier nations focused almost exclusively on securing their own vaccine supply. The result is that as of late November, nearly half of the world’s population had yet to receive a single dose of a vaccine.
Better metrics
The concept of determining a vaccine’s total value is relatively simple. Actually determining it is anything but. Real-world impacts of an infectious disease can be fiendishly difficult to quantify, and most clinical trials for vaccines are not designed to measure such things.
Nevertheless, Ferranna and her collaborator at Harvard, David Bloom, have found considerable evidence of quantifiable consequences. “Vaccinated children have better educational attainment, attend school more frequently, and also tend to perform better on tests,” Ferranna says. “That is going to affect their entire life.”
For adults, even a brief bout of flu can pull them away from work, creating economic burdens for families. For workers in low-paying service jobs, the same could threaten their employment and pressure them to work while ill, which enables the spread of disease. Ferranna notes that the ‘herd immunity’ achieved with vaccines can mitigate these issues, but, she says, “This is also not something that is typically included in the valuation of vaccines.”
Multiple efforts are now underway to develop comprehensive strategies for measuring a vaccine’s full value. Ferranna and Bloom are using a method called ‘social welfare analysis’. It assigns monetary value to the social and economic gains imparted by vaccines, including more intangible improvements in quality of life and wellbeing. The monetization approach, Ferranna says, “helps in comparing the benefits of different types of interventions.” These results can also provide the needed business cases for investments in new vaccine research and development.
Jit and colleagues in collaboration with the World Health Organization (WHO) have proposed a framework to extend the results of full-value assessments directly into decision-making to more directly drive impact and investment in vaccination programs.
The economic case for better vaccines
These vaccine value assessments, which are currently works in progress, could one day better inform research and healthcare policy and investment. In LMICs, where tight budgets require difficult spending decisions, such assessments could ensure optimal vaccine use. For example, in South Africa, where influenza claims up to 10,000 lives a year, it is nonetheless hard to justify annually vaccinating the entire population, according to Cheryl Cohen, an epidemiologist at the University of the Witwatersrand. However, she adds, a ‘universal’ influenza vaccine that confers long-lasting, broad protection against both pandemic and seasonal flu strains would tip the cost-benefit equation in its favor. “I think that would be a game-changer,” Cohen says—and not just for those who receive the vaccine, given the myriad global benefits of reduced disease transmission.
While the full value of any vaccine has yet to be determined, Pate says he hopes that funders and governments already recognize vaccines’ profound socioeconomic impact and will invest accordingly in their development and equitable distribution. “When you’re financing a global public good, it's for everyone—not necessarily tied to each country,” he says.
To learn more about vaccine valuation, check out this guide from the Value of Vaccination Research Network. To understand the ongoing effort to develop a universal influenza vaccine, explore the Sabin Vaccine Institute’s Influenzer Initiative.
The nonprofit Sabin Vaccine Institute is committed to extending the full benefits of vaccines to all people by advancing vaccine access, uptake and innovative R&D. Sabin does not develop or manufacture influenza vaccines.
