Vaccines have improved the lives of every Canadian. For instance, before tetanus immunization was available, the fear of tetanus hovered over every cut and puncture wound. Older adults will easily recall the vigour with which every childhood scrape was disinfected to protect against lockjaw and memories of family or friends paralyzed by polio and summers spent in fear. In the last 50 years, immunization has saved more lives in Canada than any other health intervention. Table 2 and Figures 1 and 2 illustrate the impact of childhood vaccines on infectious diseases in Canada. Please refer to the epidemiology sections in the chapters on Hepatitis B Vaccine and Pertussis Vaccine for additional data and charts documenting the recent successes of immunization programs against these two vaccine-preventable diseases.
Many vaccines (and some other public health interventions) result in both a benefit to health and savings in direct medical care costs. For these vaccines, the establishment of publicly funded vaccination programs improves health and results in monetary savings. Therefore, the decision to vaccinate is straightforward. Some newer vaccines result in health benefits but do not save costs. The decision to include these vaccines in vaccination programs then depends on the willingness of society to pay for the health benefits. In general, vaccination programs compare very favourably with other health interventions (Table 3). However, it is important that new vaccination programs be evaluated carefully, and that vaccine researchers and policy makers work together to identify programs that deliver the greatest benefit for the least cost.
Centers for Disease Control and Prevention. An ounce of prevention... what are the returns? 2nd edition, 1999. URL: <www.cdc.gov/epo/prevent.htm>.
Ess SM, Szucs TD. Economic evaluation of immunization strategies. Clinical Infectious Diseases 2002;35:294-7. URL: <http://www.journals.uchicago.edu/CID/journal>.
Tengs TO, Adams ME, Pliskin JS et al. Five hundred live-saving interventions and their cost-effectiveness. Risk Analysis 1995;15:369-90.
US National Immunization Program, Centers for Disease Control and Prevention. Guide to contraindications to vaccinations. URL: <http://www.cdc.gov/nip/recs/contraindications.htm#micro>.
|5-year average annual incidence per 100,000||Peak annual number of cases||5-year average annual incidence per 100,000||Peak annual number of cases|
|Diphtheria||Diphtheria toxoid introduced in 1926, routine infant immunization since 1930, national notifiable diseases reporting began in 1924||1925-29
|Invasive Haemophilus influenzae type b (Hib) in children < 5 years of age||PRP vaccine introduced in 1986, currently approved Hib PRP-T and PRP-OMP conjugate vaccines introduced in 1991/92, national notifiable diseases reporting of invasive Hib disease began in 1986||1986-90
|Measles||Live vaccine approved in 1963, MMR universal infant program implemented in 1983, 2 dose MMR introduced 1996/97, no notifiable diseases reporting from 1959-68||1950-54
|Mumps||Vaccine approved in 1969, MMR universal infant program implemented in 1983, 2 dose MMR introduced 1996/97, no notifiable diseases reporting from 1960-85||1950-54
|Pertussis||Whole cell pertussis vaccine approved in 1943, acellular pertussis vaccine replaced whole cell in 1997-98, adolescent/adult acellular formulation approved in 1999||1938-42
|Paralytic poliomyelitis||IPV approved in 1955, OPV approved in 1962 and in use in Canada until 1997, IPV used exclusively from 1998-present||1950-54
|Rubella||Rubella vaccine introduced 1969, MMR universal infant program implemented in 1983, 2 dose MMR introduced 1996/97||1950-54
|Congenital rubella syndrome (CRS)||See Rubella above. National notifiable diseases reporting of CRS began in 1979||1979-83
|* Five years preceding vaccine introduction
** Provisional numbers from National Disease Reporting System 2002-04
† per 100,000 live births
|Vaccines||Cost per life year saved|
|Measles, mumps, rubella for children||< 0 ($16 saved per $ spent)|
|DPT for children||< 0 ($6 saved per $ spent)|
|Influenza for adults aged ≥ 65 years of age||< 0 ($45 saved per $ spent)|
|Pneumococcal polysaccharide for adults aged ≥ 65 years||< 0 ($8 saved per $ spent)|
|Hepatitis B screening in pregnancy and vaccination of children of carriers||$164|
|Varicella vaccine for children||$16,000|
|Conjugate pneumococcal vaccine for children||$125,000|
|Mandatory seat belt law||$69|
|Chlorination of drinking water||$3,100|
|Smoking cessation counseling||$1,000-10,000|
|Bicycle helmet law||$39,000|
|Annual screening for cervical cancer||$40,000|
|Driver and passenger air bags/manual lap belts (vs. airbag for driver only and belts)||$61,000|
|Smoke detectors in homes||$210,000|
|Low cholesterol diet for men over age 20 and cholesterol over 4.65 mmol/L (180 mg/dL)||$360,000|
|Crossing control arm for school buses||$410,000|
|Radiation emission standard for nuclear power plants||$100,000,000|