Prevention pays off – so why aren’t we doing more of it? 

We know that immunisation pays off: the wider societal benefits of childhood immunisation programmes in low and middle income countries outweigh their costs up to 51 times while our own research on adult immunisation in mostly high and middle income shows that adult vaccines can return up to 19 times their initial investment to society, when their significant benefits beyond the healthcare system are monetised.

However, despite there being a clear evidence base for the benefits of vaccines, our research also finds that on average, current immunisation spending in many countries may be too low to meet global vaccine targets. This is all the more urgent given worrying global trends that threaten immunisation progress.

Around the world, there is growing vaccine distrust – with disastrous consequences, as we’re currently seeing with the measles outbreaks in the US. Disruptions to international aid, both by the US and the UK, has severely hindered the progress made in global health and immunisation – most notably with the threats to funding for Gavi, the global vaccine alliance.

In general, most countries – including the UK – tend to make good progress on child immunisation delivery, but seem to be overlooking the value of adult immunisations. In the UK for example, the adult immunisation framework is limited to only 5 out of 18 possible adult vaccines and mainly target people over the age of 65 and ignore the socio-economic value generation potential that a that a more inclusive vaccination strategy—extending to working-age adults—could offer.

This is despite vaccines creating vast amounts of direct and indirect value. For example, immunisation does not only prevent the vaccine-preventable disease but also frees up healthcare resources that can be used to treat others. Hence, vaccines are large opportunity cost savers, especially when waiting lists for elective care are long and workforce capacity limited. This is especially true for many seasonal adult vaccination programmes (e.g. against flu or COVID-19) that deliver protection within weeks after administration.

What causes suboptimal vaccine policies?

Three barriers stand in the way:

• Reactive healthcare systems: in the UK, for example, the NHS still functions largely as a “sick care” system, treating illness rather than valuing prevention as an investment.
• Short-term thinking: annual funding cycles make it hard to plan for the long-term; we need protected, multi-year investment in prevention, especially immunisation.
• A lack of compelling data: we’ve struggled to fully quantify and communicate prevention’s broad social and economic value to key decision-makers outside health — from finance ministries to labour and welfare departments.

How do we move towards global immunisation targets?

If we want countries to meet WHO immunisation targets, we need to invest in policy levers to incentivise action. These can be as varied as prioritising immunisation programmes, stabilising and increasing funding for them, and increasing the effectiveness of programme delivery by expanding vaccination options and integrating vaccinations into routine health check-ups.

Most importantly, we need to pivot our thinking towards viewing health as a long-term investment in society. This means prevention, both through vaccines and other interventions, must be elevated above short-term budget considerations and political cycles, acknowledging that the actual benefits of much needed investment are likely to occur in the medium-long term, and that programmes initiated now may only reap benefits under successive governments.

To realise this investment opportunity, we need to rethink both the ‘how’ and the ‘who’ of prevention funding. One potential solution is to establish a new prevention investment standard that requires prevention budgets to grow at a faster rate than overall health spending. Innovative contracting mechanisms—such as payment by results or payment over time—could help address the challenge of high upfront costs for interventions that deliver long-term benefits. Finally, employers could play a more active role by investing in prevention through occupational health programmes.

In the UK, signs are promising with prevention as a central theme of the NHS’ 10-year plan. But for this to truly happen we need to reposition prevention as an engine for productivity, equity, and resilience — all fuelled by better health.