Scientists at the U.S. Centers for Disease Control and Prevention (CDC) have explored the health and economic benefits of routine childhood vaccination during the 1994 – 2023 period of the Vaccines for Children (VFC) program in the United States.

The study is published in the CDC’s Morbidity and Mortality Weekly Report.

Report: Health and Economic Benefits of Routine Childhood Immunizations in the Era of the Vaccines for Children Program — United States, 1994–2023

Background

Immunization against vaccine-preventable diseases is the key to improving health conditions, reducing mortality, and controlling economic burdens. Widespread availability and accessibility to vaccines have significantly reduced global morbidity and mortality.

The U.S. Congress established the Vaccines for Children (VFC) program in 1994 in response to a measles outbreak in 1989. The program covers vaccination costs for uninsured, underinsured, and other eligible children. In 2023, approximately 54% of children were eligible for vaccination through the program.

Since 1994, the VFC program has covered vaccines targeting nine diseases for eligible children aged six years or below. Vaccines targeting seven additional diseases have been included in the program from 1996 to 2023. However, it is important to note that certain vaccines, such as influenza, COVID-19, and RSV, were excluded from this analysis due to differences in assessment methods or recent implementation.  

In this study, scientists have assessed the health and economic benefits of routine childhood vaccinations among VFC-eligible and non-eligible children born between 1996 and 2023.

Study design

The study analyzed the impact of nine routine childhood vaccines, including diphtheria and tetanus toxoids and acellular pertussis vaccine, Haemophilus influenzae type b conjugate vaccine, oral and inactivated poliovirus vaccines, measles, mumps, and rubella vaccine, hepatitis B vaccine, varicella vaccine, pneumococcal conjugate vaccine, hepatitis A vaccine, and rotavirus vaccine.

The health effects and cost-effectiveness of these vaccines were assessed among 30 annual cohorts of children born during 1996 – 2023.

Important observations

The study population included a total of 117 million children.

Health effects of routine childhood vaccinations

Routine childhood vaccinations were estimated to prevent 508 million disease cases, 32 million hospitalizations, and 1,129,000 premature deaths from vaccine-preventable diseases. On average, routine vaccinations were estimated to prevent four diseases and 0.3 hospitalizations in a single child.

The total number of prevented diseases ranged from 5,000 for tetanus to approximately 100 million for measles and varicella. The highest number of prevented diseases was estimated for measles vaccination (104.9 million cases), and the highest number of prevented deaths was estimated for diphtheria vaccination (752,800 deaths).

Economic effects of routine childhood vaccinations

Regarding economic effects, routine childhood vaccinations were estimated to be associated with a net savings of $540 billion in direct costs and $2.7 trillion in societal costs. The payer and societal benefit-cost ratios for routine childhood vaccinations were estimated to be 3.3 and 10.9, respectively. 

Study significance

The study finds that routine childhood vaccination is a highly cost-effective public health intervention that can prevent a wide range of diseases, hospitalizations, and deaths among children.

The VFC program has contributed significantly to these improvements in health outcomes by purchasing approximately one-half of child vaccines at discounted rates. However, accurately estimating the proportion of benefits attributable to VFC is challenging due to variations in VFC eligibility over time and differences in vaccine purchase percentages each year. Many of the studied vaccines have a coverage level of 90% or more. Financial and logistical support provided by the VFC for eligible children has substantially helped promote health equity and achieve such high coverage levels.

With societal costs of 268 billion USD for routine childhood immunization among 30 cohorts of children, the estimated savings are 2.9 trillion USD. This accounts for a savings of approximately 11 USD against every 1 USD spent on childhood vaccinations.

The CDC funds 61 state, local, and territorial vaccination programs to implement and monitor the VFC program. The organization relies on public and private healthcare providers to administer vaccines to eligible children.

A drop in childhood vaccination coverage was witnessed during the coronavirus disease 2019 (COVID-19) pandemic, partly due to reduced availability and accessibility to primary care services and increased vaccine hesitancy.

Recent measles outbreaks in the United States have prompted large-scale implementation of vaccines to protect people from highly transmissible infections.

The VFC program plays a vital role in maintaining high vaccine coverage among children who historically had lower vaccine coverage, such as children living in rural areas. It also provides the infrastructural support needed to distribute medical countermeasures to children to prevent infection transmission and reduce disease severity in outbreak settings.

As mentioned by the scientists, the program may include non-traditional vaccine providers, such as pharmacies, to increase vaccine coverage in inadequately-served areas. Strategies including provider reminders, assessment and feedback, and client reminder-recall systems should also be considered to reduce missed vaccination opportunities.

Overall, the study highlights that childhood immunizations continue to provide substantial health and economic benefits while promoting health equity.