What Routine Childhood Vaccines Saved, 1994–2023

After a resurgence of measles in the United States in 1989–1991, Congress created the Vaccines for Children (VFC) program in 1994 to give vaccines free to eligible children: those eligible for Medicaid, uninsured, underinsured, or American Indian or Alaska Native. In 2023, about 54% of children aged 18 and younger were eligible. This MMWR report estimated the health and economic benefits of routine childhood vaccination for all U.S. children — VFC-eligible or not — born from 1994 through 2023.

The vaccines

Since 1994, VFC has covered vaccines against nine diseases for children 6 and under: diphtheria, tetanus and pertussis (DTP, later DTaP); Haemophilus influenzae type b (Hib); polio (oral, then inactivated vaccine); measles, mumps and rubella (MMR); and hepatitis B. Vaccines against seven more were added to the routine schedule by 2023: varicella (1996); hepatitis A (1996–1999 in high-risk areas, 2006 everywhere); pneumococcal conjugate vaccine (7-valent in 2000, 13-valent in 2010, 15-valent in 2022, 20-valent in 2023); influenza (from 2004 for ages 6–23 months, 2006 for 6–59 months); rotavirus (2006); and COVID-19 and RSV (2023).

The analysis covered nine vaccines — DTP/DTaP, Hib, polio, MMR, hepatitis B, varicella, hepatitis A, pneumococcal conjugate and rotavirus. Influenza and COVID-19 vaccines were left out because their costs and effects are measured differently, and RSV immunization because it had only just begun.

How it was estimated

Using established models for each vaccine, the authors followed 30 yearly birth cohorts from birth to death, comparing disease rates before vaccines with rates after, based on national surveillance and coverage surveys (2022 data stood in for 2023). Costs included the vaccines, giving them, parents' travel and lost work time, and adverse events. Benefits were medical and other costs avoided and, from society's point of view, productivity lost to death, disability and time off work. Figures are in 2023 dollars, discounted 3% a year.

Results

For about 117 million children born from 1994 to 2023, routine vaccination will prevent:

• about 508 million lifetime illnesses — an average of four per child — from about 5,000 cases of tetanus to roughly 100 million each of measles and varicella;
• 32 million hospitalizations, including 13.2 million from measles vaccination;
• 1,129,000 premature deaths, including 752,800 from diphtheria vaccination.

Every dollar spent on childhood vaccination saves society about $11.

The role of VFC

VFC bought about half of all childhood vaccines in 2022, at discounted prices, and by removing financial and logistical barriers it helped keep coverage for many of these vaccines near or above 90% from 1994 to 2022. Its exact share of the benefits is hard to isolate, since children move in and out of eligibility and VFC's share of purchases varies by year and vaccine. The Centers for Medicare & Medicaid Services allocates VFC funds to CDC, which funds 61 state, local and territorial immunization programs; public and private providers give the vaccines.

Childhood vaccination coverage fell during the COVID-19 pandemic, as primary care became harder to reach and vaccine hesitancy grew, and misinformation eroded confidence. Measles outbreaks sparked by imported cases show why high coverage matters. The authors suggested that immunization programs could add pharmacies and other nontraditional providers where access is poor, and use reminders, provider feedback and reminder-recall systems to reduce missed opportunities. VFC also supports infrastructure used to distribute medical countermeasures in emergencies.

Limitations: leaving out influenza, COVID-19 and RSV vaccines understates the benefits; actual coverage may be higher than surveys show and program management costs and excise taxes were excluded, both understating costs; and falling disease risk from other causes, such as hygiene and distancing, was not modeled — though an earlier study found vaccination still saved money under worst-case assumptions.

Sources

• Zhou F, Jatlaoui TC, Leidner AJ, et al. "Health and Economic Benefits of Routine Childhood Immunizations in the Era of the Vaccines for Children Program — United States, 1994–2023." MMWR 2024;73(31). The report's social-media image is not reproduced.