The Economics and Communications of Vaccines

The Economics and Communications of Vaccines
November 16, 2016

All over the world, public health officials are working on ways to get vaccines to more people. The World Health Organization has programs all over the world to get vaccines into low to middle income countries, including their World Immunization Week in April.

Meanwhile, in the United States, the CDC and individual state governments all have planned efforts to make sure Americans stick to the vaccination schedule, and keep vaccine-preventable illnesses to a minimum.

HPV VaccineNow two new studies are looking at the costs that vaccine preventable illnesses incur in the United States, and different ways to convince people to get their flu shots.

First, researchers from UNC Chapel Hill’s Eshelman School of Pharmacy analyzed vaccination rates, disease rates and healthcare costs for vaccine-preventable illnesses and found that they cost Americans billions of dollars every year. Sachiko Ozawa, an assistant professor at Eshelman and lead author of the study, found that unvaccinated adults account for 80 percent of those costs. The findings were published in the journal Health Affairs.

Ozawa and his colleagues investigated 14 vaccine-preventable diseases covered by 10 vaccines: hepatitis A and B, measles, mumps, rubella, tetanus, diphtheria, whooping cough, meningococcal disease, pneumococcal, herpes zoster (the shingles virus) and chickenpox. They used a mathematical model to estimate the total cost of medication, inpatient and outpatient care and lost work while people were sick. The total cost came out to $8.95 billion within a range from $4.7 billion to $15.2 billion every year.

For many of those illnesses, vaccine rates are surprisingly low. According to the CDC, in 2013, only 25 percent of Americans 19 years old or older received at least the recommended three doses of the hepatitis B vaccine. Only nine percent of that same population got the recommended two doses of the hepatitis A vaccine. Pneumococcal disease vaccines had 21 percent coverage in Americans aged 19 to 64 and more than a third of Americans in that age group were not current on a tetanus booster.

Clearly, there is a wide margin for improvement and Ozawa says he hopes his study can illustrate some of the rewards for that improvement.

“We hope our study will spur creative health care policies that minimize the negative spillover effects from people choosing not to be vaccinated while still respecting patients’ right to make informed choices,” Ozawa said in a press release.

Ozawa’s study highlights some of the economic benefits of vaccination. Yet even adding financial benefits on top of the health benefits of not getting sick, people still do not get all of their shots.

H1N1 VaccineThat is where Frederick Chen, an economics professor at Wake Forest University, comes in. As an expert in the economics of public health, he studies how specific messages can help influence people to get vaccinated. His most recent study, published in May of 2016 in the journal, Health Promotion International, zeroes in on the best ways to market flu shots.

According to the CDC, anywhere from five to 20 percent of Americans get the flu in a given year, but depending on the age group, only 30 to 70 percent of Americans have gotten a flu shot in the last 12 months. According to Ozawa’s study, the flu accounted for $5.8 billion of health care costs, by far the most of any illness. So many public health officials see influenza as a primary target for vaccination efforts.

Chen’s research at Wake Forest tapped into psychology, communication and economics research to determine the best ways to target that population and get vaccination numbers up. In the study Chen suggests a number of methods to do just that.

Chen’s work suggests that a more personal touch is more effective than presenting the costs, the numbers of cases and the deaths coming from these diseases. Television public service announcements, according to Chen, should share stories of how getting a flu shot kept them healthy and that those stories have an even more powerful effect when coming from celebrities, as previous work from UNC has shown.

Another tactic could be mobilizing local volunteers to go door-to-door, a strategy that has been shown to work well in elections. Finally, Chen found that appealing to people’s personal experience of when they or someone they knew had the flu.

With flu season fast approaching, using any or all of these approaches could help prevent thousands of cases, avoid nasty illnesses and a nastier bill.

—Daniel Lane

Daniel Lane covers science, medicine, engineering and the environment in North Carolina.

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