Accounting for the full benefits of childhood vaccination in South Africa.

Abstract

While remarkable gains in health have been achieved since the mid-20th century, they have been unequally distributed, and mortality and morbidity burdens in some regions remain enormous. Of the almost 10 million children under 5 years of age who died in 2006, only 100 000 died in industrialised countries, while 4.8 million died in sub-Saharan Africa. In deciding whether to finance an intervention to improve population health, policy makers commonly weigh the expected population health gains against the costs of the intervention. Most vaccinations included in national immunisation schedules, such as measles vaccination, are both effective in preventing ill health and relatively inexpensive. Newer vaccinations, such as those with pneumococcal conjugate vaccine (PCV) or rotavirus vaccine, can effectively prevent child mortality and morbidity but are expensive relative to the vaccinations currently included in national immunisation schedules. Policy makers may therefore decide that - at current prices - the comparison of health gains with costs does not justify the free public provision of these vaccinations. We argue that in addition to the health benefits of vaccinations, their effects on education and income and their benefits for unvaccinated community members can be considerable and should therefore be included in calculations to establish the value of vaccinations.