For
most people, the choice between a life-threatening disease and a
lifetime of crippling debt is no choice at all. Yet every year, hundreds
of millions of people around the world are forced to make it, owing to
the prohibitive cost of medical treatment. And, paradoxically, the
hardest-hit people are not those with the largest medical bills, but
rather those living in the poorest parts of the world.
Although
countries like the United States have notoriously high treatment costs,
with medical debt being one of the leading causes of personal
bankruptcy, people living in poor countries actually spend more on
healthcare costs relative to their income. And, because medical
insurance is unavailable or too expensive, and because bankruptcy
protection is not usually an option, too often they and their families
end up being pushed into poverty.
But this tragedy – befalling some
of the world’s most vulnerable people – could in many cases be entirely
avoided. A new study, published in February in the journal Health
Affairs, suggests that there is another option: in many cases, the
medical bills can be preempted by prevention, through the widespread and
affordable use of vaccines.
We already know that vaccines are one of
the most cost-effective ways to prevent disease and death, and the new
study provides additional supporting evidence. By modelling the health
and economic impact of childhood vaccines for ten diseases in 41 of the
poorest countries, the researchers estimate that from 2016 to 2030,
these vaccines will prevent 36mn deaths. But their analysis found
something else: during the same period, vaccination will also prevent
24mn people from falling into poverty because of the cost of medical
treatment.
The World Bank defines “poverty” as household income of
less than US$1.90 a day. According to the World Health Organisation
(WHO), healthcare costs push as many as 100mn people below this line
every year, with 150mn others facing “catastrophic healthcare costs,”
defined as healthcare spending that consumes 40% of the household budget
after basic needs have been met.
All of this highlights the
important role vaccination has to play in helping to reduce poverty. The
fact that the study found that the greatest benefits of vaccination
were among the poorest suggests not only that poorer people are more
vulnerable and have a higher risk of developing preventable diseases,
but also that the impact on their lives is potentially greater.
For
the governments of low-income countries, this is an opportunity, because
it shows what they could achieve in terms of improving health equity
and reducing poverty by targeting higher vaccination rates in poorer and
more marginalised communities. Moreover, by making affordable, quality
healthcare available to everyone, regardless of their income,
governments can take an important step toward universal healthcare
coverage (UHC).
That is because national immunisation programmes can
act as a platform upon which to build a primary-care system. With
childhood immunisation come supply chains, cold storage, trained
healthcare staff, medical record keeping, data monitoring, disease
surveillance, and much more. So, when a community gets access to
childhood immunisation, it is often not long before it also gets access
to other services, such as neonatal and maternal care, nutritional
supplements, malaria prevention measures, and sexual and reproductive
health and education.
In addition to this, immunisation programmes
provide immense reach. Thanks to global health organisations like the
WHO, Unicef and Gavi, the Vaccine Alliance, vaccination is already one
of the most widely available health interventions ever. With 80% of the
world’s poorest children now getting access to routine immunisation –
meaning three shots of a diphtheria-tetanus-pertussis-containing vaccine
– we already have a health platform upon which to build UHC, even in
the most challenging of countries.
And now, as this new study
implies, immunisation has an additional, indirect role to play. In the
absence of a government-backed national health service or affordable
health insurance, routine immunisation has a profound financial impact,
by saving millions of people from needing healthcare in the first place,
through disease prevention.
This study builds on a growing body of
evidence that vaccines not only save lives, but also build economies.
Previous studies have estimated that every dollar invested in vaccines
saves $16 in terms of healthcare costs, lost wages, and lost
productivity due to illness, or $44 if the broader benefits of people
living longer, healthier lives are taken into account.
What this new
study now shows, however, is the tangible impact this has on people’s
lives. Over the next decade and a half, vaccines will save millions of
families from the grinding misery of extreme poverty. We now have yet
another reason to work hard to realise the enormous potential of
immunisation. – Project Syndicate
* Seth Berkley is CEO of Gavi, the Vaccine Alliance.
Vaccination plays an important role in helping to reduce poverty.