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A summary of presentations from the weekly Summit partner webinars

January 15, 2026 – The latest Summit Summary

A Valuation of Adult Immunizations: The Office of Health Economics Update – Simon Brassel, Senior Principal Economist, OHE, and Jamison Pike, PhD, MS, Health Economist, National Center for Immunization and Respiratory Diseases, CDC

Simon Brassel gave an update about economic valuation of adult immunizations, and Jamison Pike, PhD provided commentary on its application in the United States.

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A Valuation of Adult Immunizations: The Office of Health Economics Update – Simon Brassel
The Office of Health Economics (OHE) is an independent, nonprofit, research organization. This presentation was about the socio-economic value of vaccines for adults; much of the content is applicable to childhood vaccines as well.

How to Capture and Evaluate Relevant Value
A review of value frameworks used for assessment of health care systems and effects shows that virtually all frameworks split narrower and broader value elements. Vaccines have broad value and direct health effects, such as mortality, but there are also indirect health effects, such as quality of life and — according to recent evidence — impacts on noncommunicable diseases that would be captured by narrower value elements.

Research conducted by OHE looks at opportunity costs and cost offsets to the healthcare system. So, in addition to assessing the value of a vaccine by looking at the vaccine preventable outcome (e.g., the treatment cost for a case of pneumonia from flu), OHE considers the opportunity cost (i.e., what else could have been done with resources spent on vaccine preventable diseases). When these calculations were made in 2023, OHE found that:

  • The value of vaccines was underestimated by half for just the opportunity cost.
  • About 5 million deaths per year are attributed to antimicrobial resistance and about 10% of those are avoidable through immunization.
  • Vaccines impact the quality of life of carers who must care for long-term sequelae or health effects from vaccine preventable outcomes (e.g., meningitis).
  • Vaccine programs help level social equity by addressing the uneven spread of disease within society.
  • Vaccines have a transmission value, in that vaccinated people, by reducing circulation of disease, protect people who are not vaccinated.
  • Vaccines often provide value by increasing the cost effectiveness of other interventions.
  • There are broader socio-economic effects, such as the impact on productivity of the individuals and the people who care for them.
    • For example, the productivity losses due to absenteeism from vaccine preventable disease in the UK was $44B per year, according to research published by OHE 2 years ago.
    • There is evidence that, over 2 years, COVID-19 immunization generated $2.6T in macroeconomic value.

A Model for the Process of Capturing Value
[This model may not work in the United States, due to privatization of health care.]

  1. Ministry of Finance allocates public budgets across sectors, including Ministry of Health.
  2. Ministry of Health then has to allocate their budget across various health interventions (e.g., primary care, pharmaceuticals, vaccinations), and part of that calculation — i.e., what allocations will result in maximal health benefits (and therefore also wealth benefits) in the population — includes an assessment of what will get the most value (a complicated measure) for their budget.
  3. Many countries (especially in Europe) use cost effectiveness or cost utility analysis to assess the biggest potential health gains, but that may not be enough.
  4. Benefit cost analysis gives insight into how society values the gains and expresses everything in monetary terms, which allows for analysis across sectors.
  5. Opportunity costs still must be considered.

Considering the Broader Value of Vaccination
In 2025, for high income countries (not including the United States), OHE did an analysis on the burden of COVID-19 in one year. Across all countries included, on average, about 80% of the burden falls outside the health system; however, most health spending decisions are still being made from just the health system perspective.

Examples of Recent OHE Analyses

  • OHE conducted a project funded by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) to estimate the societal ROI of four adult vaccination programs in 10 countries.
    • Comprehensive literature review across four diseases
    • Benefit-cost analysis of the four vaccination programs when diseases were established or emerging
    • The monetized benefits generated far outweigh the costs required to achieve them:
      • For each dollar spent, $19 are created in societal benefits
      • Landmark research on childhood immunization, mostly in low- and middle-income countries, has shown a benefit cost ratio of 50 (i.e., for each dollar spent, $50 are created in societal benefits)
    • OHE worked with Pfizer in 2025 (publishing currently) to analyze four adult respiratory disease programs in the United States and found that the programs generate over $4T in societal net benefits across the lifetime of all model populations, with a benefit cost ratio of 50 to 1.
      • Unfortunately, there is much value left on the table due to low coverage rates.
    • OHE also found that adult immunization can deliver fiscal returns to public funders (study done in the UK) when they analyzed models that showed the potential outcomes of COVID-19 vaccination for either the general population between 18 to 64 years of age, only those in clinical risk groups, or only those who work in healthcare or are caregivers. They found that with vaccination in the 18 to 64 group, 65% of the invested money would be recouped due to a better tax base and lower benefit payments, with even better returns for the subgroups.

Why Is This Important for Supporting Vaccination Campaigns?

  • In general, vaccination campaigns suffer from undervaluation, underfunding, and low uptake
    • On average, countries (excluding the United States) spend 0.08% of their GDP on immunization. The United States, in 2023, spent 17.2% of the GDP on health, with 0.6% of that on prevention.
      • For both of those budgets, the percentage spent on prevention — and, hence, immunization — is relatively low. There are very few countries, for example, that consistently reach the WHO target of 75% coverage for flu.

Key Takeaways

  • To value vaccination in adults, broader value elements should be captured within the healthcare system and outside the healthcare system.
  • To unlock this value, various forms of economic evaluations should be explored in complement to traditional cost effectiveness analysis, value generation should be matched by allocated budgets, and opportunity costs in other sectors should be considered.

Per the saying, “Vaccines don’t save lives, vaccination does,” there are many other issues to explore, such as low coverage rates and implementation challenges.

QUESTIONS & ANSWERS

Q: Economic models are so dependent on the assumptions that are made within them — As you’re looking to expand to more assumptions being built in with these broader value elements, is there an effort to standardize some of those basic, foundational things, like the disease and the vaccine, so that as people modify the other value elements, you’re getting a meaningful result that’s consistent (because you’re not changing too many things at one time)?
Simon Brassel (OHE): Yes, absolutely: The more we add, the more we add to the uncertainty of analysis, and in health economics, I find vaccines interesting because they are complex. I think the only thing, as a health economist, that is more complex is antimicrobial resistance, but vaccination is a really complex issue, and the models are unusual. Normally, in health economics, we have a lot of models that run for 5 years, and vaccination is often something where you look at lifetime. So, there’s a lot of uncertainty, a lot of impact of discounting, of long-term benefits, and so on. Whatever we can standardize along the way is very much needed and wanted. On your point of potentially standardizing parts of the disease models, why not? In a lot of health economics this is a big problem — that everybody uses their own models and makes their own assumptions; we put a lot of effort into challenging those and making sure they are right. So having more standardized models that we can populate but are also accepted by different stakeholders, and we can build off them — this is a fantastic idea.
Q/Follow-up: With the ACIP meetings, we would often have one or two industry models, and a university model, and then the CDC model, and we’d look across all of them and say these are all the reasons they’re coming up with such different results. So, I think that one way to make this more impactful is to come up with some standardized foundational models that people can then build on transparently to see some of these other enhanced benefits from the broader value. Because those numbers, whatever they are, as soon as they are spoken or seen become scripture. In meetings, you see those who don’t understand economic modeling take them as gospel, and they’re like, “This is what it is.” So, a bad model can quickly lead to a bad policy decision. Averting that would be useful.
Simon Brassel (OHE): I absolutely agree.

Q: Dr. Pike [health economist from CDC and NCIRD], could you share some of your thoughts about the presentation and how those broader value elements apply in the United States, and about the comments on ACIP and looking at those narrower health determinants?
Jamison Pike (CDC): It was a great presentation. I love benefit-cost analysis, and we just don’t use it here at CDC. It’s great to see value of statistical life used, too, and I think there’s a lot of benefit. And I was very glad to hear you say, “to complement,” because I do think, particularly from an academic perspective, you want that big picture, it is so important. But when we get into the nitty-gritty here at CDC or in front of ACIP, they want to know about all that data behind it and how the disease model works. When we look at cost-effectiveness for one vaccine, hospitalization rates…[there] could be anything [that] could make a huge impact on that cost-effectiveness analysis. And so that’s why that has been used. I didn’t even know what cost-effectiveness analysis was until I came to CDC over 10 years ago. I understand why ACIP liked to use it, historically. So, I do think that’s complementary. The other thing, we get so focused on coverage; you can look at all of this, but if you’re not going to get good coverage, and you have such different coverage rates across the different vaccines that you’re looking at…if we don’t understand that, then how to get that up, then “Yes, let’s invest all this money into adult immunization,” but if we don’t really understand how to use that money so that it makes a difference in coverage, then it’s not going to have the result we’re hoping for. I think this work should be complementing cost-effectiveness analysis. This is just my opinion, and that is basically all we do is cost-effectiveness analysis here. Also, multiple people were talking about caregiver time and productivity losses. I’ve done a lot of work in that area, and we are trying to work that in everywhere, in all our analyses; that has been a big missing component in a lot of economic analyses here.
Simon Brassel (OHE): I 100% agree, and I think it’s important for me to say that I really see this as a complement. We have cost-effectiveness analysis, which is a different tool for a different job from a different perspective, and it adds a little bit to this wider perspective, or also potentially allows us to make comparisons. Also, we must be careful about other sectors and to explore this question of whether immunization budgets, currently, are justified in terms of what value they generate for society. I think they are helpful tools, for example, to come a little bit closer, but I also think it’s a complement to cost-effectiveness analysis, or cost utility analysis, what we’re doing in Europe.
Jamison Pike (CDC): Take that number and use it. Right now, more than ever, we need to know exactly where that number came from. How can it really translate to every [situation] … I do a lot of measles work right now, and they take one cost-of-outbreak study, and they’re like, “Can’t we apply that to every cost-of-outbreak study?” No, you can’t. That is what you must be super careful about.
Simon Brassel (OHE): I agree.
Jamison Pike (CDC): But this is really interesting work, and I’m so happy that it’s being done.

Q: Could you talk about your approach with policymakers and how you help make the information understandable?
Simon Brassel (OHE): I often think that people in academia, but also in the area where we work (non-profit research institutes), have that as the main objective: We don’t do that research so that it’s done; we really want to create impact and want to talk about it, and this is one project where we actually talked about quite a lot worldwide. We were invited to different meetings and stakeholder groups: G20, site events, WHO meetings, media engagements. Because it was a project also that spanned multiple countries, we went to different countries to engage with policymakers directly, and I do think it has impact. In the UK, for example, there was a recent House of Lords briefing, basically a research briefing for lawmakers where a lot of that research in our benefit-cost analysis work, and other work that we’re doing now for the last 7 years at OHE around broader value of vaccination, is referenced. Obviously, you can never do enough; but specifically for that project, we have many different forms of engagement, roundtables and so on, where we do get directly in contact with policymakers.
Jamison Pike (CDC): For us right now, we’ve done economic training for our ACIP members, historically, and anybody who wants that. They always ask for it by the numbers. They want to know “Where are we at by the numbers?” And they want cost numbers, but it makes me nervous, too, to give those numbers, because of exactly what we’ve been talking about. They’re not always transferable. We have an economist here who does trainings on how the models work and who is a fabulous teacher, and he just does training sessions for them. I can’t really speak to what our method is to get them to understand it, but I would say that is probably why cost-effectiveness is used, is because often, they’ve been using it for a long time, and they can understand it. And cost-benefit is not always as easy: When they can say a cost per avoided something, it’s easier to understand. And the benefit-cost analysis may be a little bit more — I don’t want to say accurate, but —inclusive of all the benefits and all the costs… it might have less in it, but it’s easier to understand. Is that the case in the UK?
Simon Brassel (OHE): In the UK, the National Institute for Health and Care Excellence (NICE), for example, would not use a benefit-cost analysis, but it’s also not necessarily the stakeholder that you want to address. It’s more, maybe, the Ministry of Finance or something, just to showcase that there’s a lot of value in this vaccination, and to compare between different options. A benefit-cost analysis…if we monetize everything, all the outcomes, and you can argue that a lot of that value also in our models is mortality risk reduction, because the value of statistical life basically picks that up a lot — it’s a significant value driver. But it is relatively easy to understand, because you can say we express all these outcomes in kind of a monetary unit, and then we divide it by the costs that we have in order to achieve them. The only thing is, what does that benefit-cost ratio mean? A lot of people think, “Okay, you spend £1, you get £19 back in your bank account,” and that’s not what it means. It’s like the valuation of benefits, how society sees these valuations. So that’s why I think it’s important to talk about different perspectives, and for which stakeholder it is the best form of economic evaluation. I just do think we can use different forms in complement to each other to get a clearer picture.
Jamison Pike (CDC): The stakeholder rings true as well, because the people that we’re talking to don’t always think about the societal perspective, they think about the individual perspective, or their state’s perspective, or their county’s perspective, and so sometimes it’s hard to step back and say, “Let’s think about the whole population.”
L.J Tan (Immunize/NAIIS): That resonates. I think for the translation of this type of information for policymakers, you have to look at the policymaker you’re trying to influence, and that’s why I think what is being said here is also to look at that audience and then pick the analysis, or combine the different analyses that you think will be easiest for them to understand. It sounds like cost-effectiveness is one that’s straightforward, assumptions aside.

Q: Regarding models for looking at some of these broader societal values — the non-sedating antihistamines, presenteeism work that was done by insurance company employees — have you seen studies that can be translated to look at some of these broader societal values for immunizations? How do you address that gap? Are there studies that are being done by non-traditional, non-immunization partners that can be adapted and used?
Simon Brassel (OHE): Not to my knowledge. A lot of that work about immunization is relevant for prevention in general. So, any preventative intervention has similar challenges to an immunization program. You see high upfront costs in the beginning with uncertain outcomes over a longer period. How do you finance that? What are the financial mechanisms, for example, to fund that? I think these are important questions to answer, not just for immunization but for other preventative interventions as well.
Jamison Pike (CDC): There’s much more work done in chronic diseases than there is in vaccine-preventable diseases, and there are new surveys and different ways of trying to capture that, that we’re attempting to borrow, but it’s all still being developed. I think there is a movement, because I get a lot of papers to review in this area, so I do think a lot of people would like to see this, but there’s more going on in Europe than there is in the United States. Netherlands, of course, is always doing a lot of progressive work in this area, but again, it’s usually centered around chronic disease, not around immunization, so we just kind of borrow.

Q: What about linking the impacts demonstrated in the exacerbation of chronic diseases to the impacts on those diseases from the vaccine preventable diseases, especially viral respiratory infections?
Jamison Pike (CDC): Like a high-risk population? We do that with cost-effectiveness analysis. We look at those certain populations: how does their incidence or hospitalization look different, so we do consider those chronic diseases.
Simon Brassel (OHE): If the question relates basically to the impact of vaccination on NCDs, for example, we’re currently seeing more evidence that there is potentially a protective effect on certain chronic diseases, cardiovascular or Alzheimer’s. If evidence is there, if we can measure that, that could be captured then as simple as a health effect of vaccination: that it’s not just the vaccine-preventable outcome that we currently know, but if there’s more evidence there, then that would be something that I think current value frameworks, even the narrow ones, could capture. That should be no problem, if the evidence is there that the status quo would allow for that. That is not even a broader value in that sense, that is just a knock-on effect on a health outcome.

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