When public health budgets face scrutiny, the question of whether mass vaccination programs are worth their cost becomes politically charged — yet until now, no systematic economic accounting existed for the WHO's flagship immunization effort across its full five-decade history. This Lancet Global Health analysis fills that gap with striking precision, and the numbers reframe the conversation entirely.
The study evaluated the Expanded Programme on Immunization (EPI) across 194 WHO member states from 1974 through 2024, covering 14 major pathogens including measles, polio, diphtheria, hepatitis B, rotavirus, tuberculosis, and yellow fever. Using a counterfactual framework — comparing observed EPI outcomes against a modeled scenario with no vaccination — researchers calculated both benefit-cost ratios (BCRs) and incremental cost-effectiveness ratios (ICERs). Total EPI expenditure over the period reached approximately US$93 billion when accounting for vaccine procurement, administration, and family-level time costs. Benefits were anchored primarily to averted mortality drawn from established global burden-of-disease estimates, spanning all 194 member states at regional and national resolution.
The analytical architecture here is methodologically ambitious. By synthesizing procurement data, administration costs, and household opportunity costs alongside long-run mortality burden estimates, the researchers constructed what is arguably the most comprehensive longitudinal cost-effectiveness portrait of a single public health intervention ever attempted. That scope is also a limitation: aggregating 50 years of heterogeneous data across low-, middle-, and high-income settings introduces compounding uncertainty, and the counterfactual scenario — assuming zero vaccination — is necessarily hypothetical. Averted mortality also captures only a fraction of total benefit; morbidity reduction, educational gains, and productivity preserved in survivors are harder to monetize and likely underrepresented here. Still, even conservative BCR estimates for programs of this scale tend to be robustly positive, and this study appears confirmatory of that consensus while adding regional granularity that policymakers have lacked. For health economists and global health advocates, this is a landmark reference document.