A brief but important bit of good news today. Stop me if you’ve heard this before on Science-Based Medicine, but vaccines have saved many lives since the very late 18th century when Edward Jenner first published his work on the prevention of smallpox through inoculation with the cowpox (vaccinia) virus. Most of these saved lives have been young children dependent on the choices made by the families and the governments that they just happened to have been born into.
One of the most important of the choices made here in the United States has been the Vaccines for Children (VFC) program. Established in 1994 through an Act of (a more functional) Congress, the VFC program had its origins during the aftermath of several large measles outbreaks occurring from 1989 through 1991 across the country. These outbreaks primarily involved children, particularly unvaccinated infants and toddlers from racial/ethnic minority groups living in so-called “inner city” areas. Thousands were infected and several young children died.
The VFC program was established so that all recommended vaccinations would be made available without cost to eligible children. This includes kids 18 years and younger that are eligible for Medicaid, uninsured, or whose insurance does not include coverage of the recommended vaccines. Also included are children from the high risk American Indian and Alaskan Native populations. The VFC program is made up of more than 60 state, local and territorial programs funded by the CDC.
So has the VFC program been successful over the past 30 years? Yes, it has. And spectacularly so. For just one example touted by the CDC in a recently published report, close to 90% of eligible children from 2011 through 2020 received the MMR vaccine regardless of race, ethnicity, SES, or locale. These are kids that would have been at significant risk of slipping through the cracks otherwise, and could have kicked off an outbreak or helped spread measles during one of the several outbreaks that have occurred recently.
The research team behind the CDC report mentioned above set out to “assess and quantify the health benefits and economic impact of routine U.S. childhood immunizations among both VFC-eligible and non-VFC-eligible children born during 1994-2023.” They found that among the approximately 117 million children born during this period, vaccinations prevented more than half a billion lifetime cases of illness, 32 million hospital admissions, and about 1.1 million deaths. They estimated a net savings of $540 billion in direct costs and $2.7 trillion in societal costs. That’s a lot of costs!
It’s clear, in my opinion, that vaccines save lives and are extremely cost effective as public health interventions. It is a bit complicated, however, to gauge exactly how much the VFC program specifically has contributed to the overall societal benefit of vaccines. Many children move in and out of eligibility and may have received some of the immunizations without requiring help from the program, for example. And the number of vaccines purchased by the program changes from year to year and from vaccine to vaccine. But to give some important perspective, the program handed out more than 70 million vaccines in 2023 alone. The recipients of these vaccines were all less likely to have had access to them otherwise because of financial hardships, which makes it is hard to argue that the impact could be anything but significant.
And this report didn’t even include influenza, COVID-19, and RSV immunizations in the analysis, meaning that it could have underestimated the health and economic benefits of childhood vaccines overall. To be fair, it might also be an overestimate. It is challenging to take hygiene and precautions such as physical distancing into account for some illnesses, meaning that vaccines might not have prevented as many cases as assumed, but the authors conclude that routine childhood shots are cost-saving even with a “worst-case scenario assumption”.
What about global immunization efforts? In April, the WHO put out a study which held up immunizations to be the most important contribution of any health intervention when it comes to making sure that babies reach adulthood. They found that the measles vaccine has been the most important of the past 50 years, giving it credit for 60% of all lives saved due to immunization. Overall, worldwide vaccinations have saved more than 150 million lives and added 10.2 billion full health years over the past 5 decades.
As great as this all sounds, it isn’t good enough. There are still millions of children at risk around the world, a decent number of which are here in the United States. Efforts like the VFC program obviously need to be expanded, but we also need to develop more effective ways to reach the vaccine hesitant caregivers out there as well. Misinformation and disinformation is rampant these days, and it goes all the way to the top of many local and state governments. And we are currently facing the potential, again, for it to come from the White House. If only there was something that people who care about the health of children, and adults too for that matter, could do…in November perhaps.