Economic Evaluation of Vaccination Programs: The Impact of Herd-Immunity

Med Decis Making. Jan-Feb 2003;23(1):76-82. doi: 10.1177/0272989X02239651.


The unique characteristic of vaccination is that it not only reduces the incidence of disease in those immunized but also indirectly protects nonvaccinated susceptibles against infection (produces herd-immunity). The bulk of economic evaluations of vaccination programs continue to use models that cannot take into account the indirect effects produced by herd-immunity. Here, the authors illustrate the importance of incorporating herd-immunity externalities when assessing the cost-effectiveness of vaccination progams. To do this, they compare 2 methods of estimating the benefits of routine mass vaccination: one that includes herd-immunity (dynamic approach) and one that does not (static approach). Finally, they use the results to clarify a number of misconceptions that are common in the literature concerning herd-immunity and dynamical effects produced by models.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Chickenpox / epidemiology
  • Chickenpox / prevention & control
  • Chickenpox / transmission
  • Child
  • Child, Preschool
  • Computer Simulation
  • Cost-Benefit Analysis / statistics & numerical data*
  • England / epidemiology
  • Humans
  • Immunity, Herd*
  • Incidence
  • Infant
  • Infant, Newborn
  • Mass Vaccination / economics*
  • Middle Aged
  • Models, Statistical*
  • Wales / epidemiology