Vaccinating against poverty

Formost people, the choice between a life-threatening disease and alifetime of crippling debt is no choice at all. Yet every year, hundredsof millions of people around the world are forced to make it, owing tothe prohibitive cost of medical treatment. And, paradoxically, thehardest-hit people are not those with the largest medical bills, butrather those living in the poorest parts of the world.Althoughcountries like the United States have notoriously high treatment costs,with medical debt being one of the leading causes of personalbankruptcy, people living in poor countries actually spend more onhealthcare costs relative to their income. And, because medicalinsurance is unavailable or too expensive, and because bankruptcyprotection is not usually an option, too often they and their familiesend up being pushed into poverty.But this tragedy – befalling someof the world’s most vulnerable people – could in many cases be entirelyavoided. A new study, published in February in the journal HealthAffairs, suggests that there is another option: in many cases, themedical bills can be preempted by prevention, through the widespread andaffordable use of vaccines.We already know that vaccines are one ofthe most cost-effective ways to prevent disease and death, and the newstudy provides additional supporting evidence. By modelling the healthand economic impact of childhood vaccines for ten diseases in 41 of thepoorest countries, the researchers estimate that from 2016 to 2030,these vaccines will prevent 36mn deaths. But their analysis foundsomething else: during the same period, vaccination will also prevent24mn people from falling into poverty because of the cost of medicaltreatment.The World Bank defines “poverty” as household income ofless than US$1.90 a day. According to the World Health Organisation(WHO), healthcare costs push as many as 100mn people below this lineevery year, with 150mn others facing “catastrophic healthcare costs,”defined as healthcare spending that consumes 40% of the household budgetafter basic needs have been met.All of this highlights theimportant role vaccination has to play in helping to reduce poverty. Thefact that the study found that the greatest benefits of vaccinationwere among the poorest suggests not only that poorer people are morevulnerable and have a higher risk of developing preventable diseases,but also that the impact on their lives is potentially greater.Forthe governments of low-income countries, this is an opportunity, becauseit shows what they could achieve in terms of improving health equityand reducing poverty by targeting higher vaccination rates in poorer andmore marginalised communities. Moreover, by making affordable, qualityhealthcare available to everyone, regardless of their income,governments can take an important step toward universal healthcarecoverage (UHC).That is because national immunisation programmes canact as a platform upon which to build a primary-care system. Withchildhood immunisation come supply chains, cold storage, trainedhealthcare staff, medical record keeping, data monitoring, diseasesurveillance, and much more. So, when a community gets access tochildhood immunisation, it is often not long before it also gets accessto other services, such as neonatal and maternal care, nutritionalsupplements, malaria prevention measures, and sexual and reproductivehealth and education.In addition to this, immunisation programmesprovide immense reach. Thanks to global health organisations like theWHO, Unicef and Gavi, the Vaccine Alliance, vaccination is already oneof the most widely available health interventions ever. With 80% of theworld’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 inthe most challenging of countries.And now, as this new studyimplies, immunisation has an additional, indirect role to play. In theabsence of a government-backed national health service or affordablehealth 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 ofevidence that vaccines not only save lives, but also build economies.Previous studies have estimated that every dollar invested in vaccinessaves $16 in terms of healthcare costs, lost wages, and lostproductivity due to illness, or $44 if the broader benefits of peopleliving longer, healthier lives are taken into account.What this newstudy now shows, however, is the tangible impact this has on people’slives. Over the next decade and a half, vaccines will save millions offamilies from the grinding misery of extreme poverty. We now have yetanother reason to work hard to realise the enormous potential ofimmunisation. – Project Syndicate* Seth Berkley is CEO of Gavi, the Vaccine Alliance.