Prevention not reaction: Why investing in vaccination programs pays off

Vaccinations are considered one of the most effective measures to protect people from infectious diseases – no other health measure has saved as many people from death over the last 200 years. This article provides an overview of the history of vaccination, strategic approaches to vaccination motivation, and what impact vaccination has on the overall society. 

Prevention not reaction: Why investing in vaccination programs pays off

The history of vaccination  

The history of vaccination begins with the fight against smallpox. The viral infection, which had been raging since the 600's A.D., had cost millions of lives over the centuries. As late as the 18th century, in particular babies and young children were still dying from the pustular rash. Attempts to immunize smallpox sufferers failed time and time again. The scientific breakthrough finally came in 1796, when the English country doctor Edward Jenner infected a boy with a related pathogen, the cowpox virus, through an incision in the upper arm. What is considered an unethical experiment from today's perspective, marked the birth of the first protective vaccination. An acquaintance of Jenner's, Richard Dunning, then coined the term vaccination – after the Latin word vacca for cow – for the method developed by Jenner at the turn of the century.  

In the 20th century, experience with smallpox vaccination and the discovery of pathogens led to the development of further vaccines. First and foremost, among these were the scientists Louis Pasteur and Robert Koch. Pasteur is considered the inventor of the rabies vaccine. Together with Koch, he also discovered the pathogen that causes anthrax, against which they were also able to develop a vaccine. Other milestones in the history of vaccination include the discovery of vaccines against diphtheria and tetanus by Emil von Behring and Paul Ehrlich.   

These groundbreaking developments mean that vaccinations are now among the most successful health measures of all time. The last cases of smallpox were reported in the mid-1970’s, and in 1979 the WHO declared the disease eradicated. Today, vaccinations protect against many diseases and are estimated to save three million lives worldwide each year. 

1727 / 1728: First vaccination statistics 1796: First vaccination in history: discovery of smallpox vaccination - Edward Jenner; 1807 / 1808: Introduction of compulsory vaccination in the Kingdom of Bavaria and Grand Duchy of Hesse1864: Germ theory explanation for the development of epidemics - Louis Pasteur; 1870 / 1871: Smallpox epidemic in Germany1881: Detection of bacterial pathogens of tuberculosis - Robert Koch; 1881: Proof of the active principle of immune defense - Émile Roux  1881: Vaccine against anthrax - Louis Pasteur & Émile Roux; 1885: Vaccine against rabies - Louis Pasteur & Émile Roux; 1890: Discovery of antitoxins and thus passive immunization - Emil von Behring1890: Vaccines against diphtheria & tetanus - Emil von Behring, Paul Ehrlich & Shibasaburo Kitasato; 1893 / 1894: First vaccines against cholera - Jaime Ferrán1908: Identification of the poliovirus - arl Landsteiner & Erwin Popper; 1925: Discovery of so-called "adjuvants" to increase the effectiveness of vaccines - Gaston Ramon & Alexander Glenny1926: Vaccines against tetanus & pertussis - Emil von Behring; 1936: Vaccines against money fever & influenza (flu) - Max Theiler 1952 / 1953: Introduction of the Toronto method: enabling mass production of viruses (initially polioviruses) for vaccines - Leone Farell; 1955 / 1961: Vaccines against polio (poliomyelitis)  - Jonas Salk & Albert Sabin1960’s: Vaccines against measles, mumps & rubella - Maurice R. Hilleman; 1966: WHO launches the “Smallpox Eradication Program” to stop the spread of smallpox among the 60% of the world's unvaccinated population 1974 / 1975: WHO launches the Expanded Program on Immunization (EPI), which requires six vaccinations for children 1979 / 1980: WHO announces worldwide eradication of smallpox as the first infectious disease to be eradicated; 1980’s: Vaccines against hepatitis B, pneumococcus & chickenpox; 1989: First description of mRNA agents - Robert Malone 1995: Vaccine against hepatitis A - Maurice Hilleman; 2021 - The first mRNA-based vaccine receives regulatory approval

Strategic approaches to vaccination motivation  

Although vaccination is one of the most successful health interventions, various reasons such as skepticism, fear, or lack of information can make people reluctant to get vaccinated. Therefore, there are different approaches to improve vaccination motivation – from alternative forms of application to humanoid robots.

Alternative forms of application  

In a 2018 survey by the German Federal Center for Health Education (BZgA), as many as 6 percent of participants said they were afraid of injections. This fear could be circumvented with other forms of application. In fact, some vaccinations already do not require a needle. For example, a vaccination spray against influenza has been available for several years, and other forms of application such as microneedle patches are being tested. Studies have shown that the vaccination rate in groups who were offered the alternative form of administration was higher than with conventional administration.  

Humanoid robots  

To counteract fear of vaccination in children, the use of humanoid robots that distract children from vaccination is being studied. Studies show that this can reduce stress as well as pain.   

Motivational interviewing   

Motivational interviewing (MI) can be a successful intervention when individuals refuse vaccination due to misconceptions or lack of information. In MI, patients' concerns and ambivalences are addressed and existing worries are reduced through education. In this way, individuals can be motivated intrinsically.  

Nudging  

Among other things, nudging is emerging as a promising measure. Nudging is a technique that influences decision-making architecture to nudge people's behavior in a particular direction. In the context of vaccination, several studies have shown that providing more information, for example, pointing out vulnerable groups or the limited availability of vaccines, can increase vaccination rates.   

Vaccination visits  

In some cases, lack of willingness to be vaccinated is not necessarily related to skepticism, fear, or a lack of information. Certain physical conditions can also make it difficult to visit a doctor.  As a result, some German health insurance companies offer that some people can get vaccinated at home – for instance when being unable to visit a doctor's office on their own due to a degree of care or an inability to walk. This is another way of reducing the barrier to getting vaccinated and helping to increase vaccination rates.  

Background: Investment in vaccination programs  

The European Union invests about 8.3 percent of gross domestic product in health spending, of which only 3 percent is in prevention. Despite their significant role in disease prevention and the fact that vaccination is considered one of the most effective and often even cost-saving primary prevention interventions, vaccination programs account for only a small proportion of this 3 percent 

In Germany, the STIKO recommends which vaccinations are of high value for the health protection of individuals and the general public in order to prevent communicable diseases. It bases its recommendations largely on the results of so-called medical benefit-risk assessments. Furthermore, in certain cases, the standard operating procedure (SOP) additionally provides for epidemiological methodological models (EM) and / or health economic evaluations (GE) to model future effects beyond the medically based assessment by the benefit-risk assessment and to determine the most efficient vaccination strategy. Such methodological models and health economic evaluations, while not yet the standard approach of the RKI in Germany, routinely inform the recommendations of most vaccination committees in Europe. This has led to a lively discussion about the methodology of these epidemiological-methodological models and health economic evaluations.  

The discussion is primarily driven by the demand to expand the existing framework, which is often limited to direct medical effects. Only in this way can the societal value of vaccines be reflected. This is because, in addition to direct medical effects, vaccines have other benefit dimensions in the economic and societal sense. 

Economic impact of vaccination  

In addition to the fact that vaccinations have a positive impact on individual and societal health through immunity and reduced contagion, economic growth is also affected through various mechanisms. For example, improved health due to vaccinations results in fewer sick days, which can be translated and monetized into paid as well as unpaid work. Proposals on the benefit dimensions to be taken into account thus go beyond herd immunity. They call for consideration of, for example, productivity effects of affected individuals and potential caregivers, social insurance, economic growth, or even aspects of social justice. They argue that only if the corresponding benefit dimensions are taken into account the actual value of vaccinations can be determined.

In the study “Social Impact of Innovative Medicines”, among other things, you will gain insights into current analytical methods used in HTAs as well as the Social Impact approach, in which the value of medical innovations is redefined:  

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