What Would It Cost to Vaccinate Every Child for Everything?
Photograph by Adrian Brooks
The answer is: roughly $250 billion (US). That is, every child, from birth to age 19, could be vaccinated against 15 common and often deadly or disabling diseases at a cost of just over $250 billion. This is a back-of-the-envelope estimate (with all sources and assumptions detailed below) as a simple thought experiment meant to indicate whether such a goal is even conceivable.
But before going into the details, its worth asking whether $250 billion is even a possible, let alone realistic, goal for such a campaign. Surprisingly...yes, it is. For example, if the 100 richest individuals in the world each contributed $2.5 billion, the poorest among them would still have $7.7 billion left over. The top 25 could each contribute $10 billion, and the poorest among them would still have $13.8 billion. [ 1 ]
And although $250 billion seems a nearly incomprehensible figure to most of us, it is in fact more commonly attainable than we might imagine.
Apple has pledged to return $250 billion in dividends to its shareholders. [ 2 ]
Americans have contributed over $250 billion to 529 college savings plans. [ 3 ]
In 2015 alone, Americans (individuals, estates, foundations, and corporations) gave more than $370 billion to charity. [ 4 ]
That said, let's take a closer look.
The Population
The UN makes the following estimates of childhood population by age group for the year 2017 [ 5 ]:
The Vaccines and the Costs
Gavi lists projected 2017 per dose prices for 15 vaccines. [ 6 ] Selecting the lowest provider costs for each vaccine, the total price is just $18.58. In contrast, the total highest provider price, adjusted for wastage is $54.93. Any realistic estimate for universal vaccinations though would also have to take into account such costs as transportation, maintaining a cold chain, training personnel to administer the vaccines, record-keeping, and more. I admit to not knowing what these other support costs total, but taking the most conservative $54.93 figure and rounding it up to $100 doesn't seem an unreasonable estimate of the per person cost for the 15 vaccines. (And if, for example, the real cost is closer to $200, simply double all of the figures below.) All of which brings us to the total for all age groups, birth through 19, of $252.6 billion.
Some Considerations
There are any number of factors that could affect these numbers, either up or down. Here are just ten to consider, though there are certainly many more:
The mix of vaccines for any one country will surely vary from that for other countries. For instance, the CDC lists 17 (not 15) vaccines recommended for American children: cholera, Japanese encephalitis, and yellow fever are not recommended for Americans, but influenza (IIV, LAIV), mumps, meningococcal, varicella (VAR), and hepatitis A are. [ 7 ]
These vaccines could not be administered to a child all at one time, meaning additional costs for travel, storage, etc.
Population density could be a major, inverse, cost factor.
Infrastructure (roads, communications, and electricity) varies greatly from country to county.
Governments will surely contribute, either in funds or in-kind, to support such a universal campaign, contributing to an overall cost reduction.
Per dosage vaccine costs will most likely fall if total dosage production reaches into the hundreds of billions.
As a simplifying assumption, we've looked at only one year (2017) but a campaign of this magnitude will take many years, during which time there will be many millions more children born, all of whom will need to be vaccinated as well.
Significant numbers of infants and children are already vaccinated, reducing the number who would need to be vaccinated. [ 8 ]
A campaign of this size is likely to spur innovations, e.g., eliminating the need for booster shots, eliminating the need for a cold chain, developing a new pentavalent-type vaccine combining several vaccines into a single dose. [ 9 ]
It would be naive to assume that parents worldwide would automatically know about, understand, and support vaccination. This campaign will need to be accompanied by a large and sustained program of education. Which...could also be a significant bonus; having the opportunity to present vaccine education to parents across the globe could be leveraged to educate on other health matters as well.
Conclusion
Not discussed so far is the economic and social leverage that would accompany universal vaccination of children. Fewer infant deaths would probably lower the birth rate which means fewer women would die in childbirth, etc., etc. The 'chains of good' that would result from vaccination would be many and significant. A net social benefit calculation is beyond the means of this blog but should not be discounted or overlooked.
As a simple, what-if speculation, a universal campaign to vaccinate every child against the most deadly diseases turns out not to be an unreasonable goal. Even if the cost were double what I've suggested (say, $500 billion dollars) and the practicalities far more complex and difficult than expected, there's no logical reason it couldn't be done, and there is every reason to try.
Notes
[ 1 ] http://www.forbes.com/billionaires/list/#version:static
[ 2 ] http://www.apple.com/pr/library/2016/04/26Apple-Reports-Second-Quarter-Results.html
[ 4 ] http://givingusa.org/giving-usa-2016/
[ 5 ] United Nations, Department of Economic and Social Affairs, Population Division. https://esa.un.org/unpd/wpp/DataQuery/
[ 6 ] Cholera, HPV, Polio vaccine - inactivated (IPV), Japanese encephalitis (JE), measles, rubella, meningitis A, pneumococcal conjugate vaccine (PCV13), rotavirus, yellow fever, diphtheria, tetanus, pertussis, hepatitis B, and Haemophilis influenzae type b (Hib). See http://www.gavi.org/library/gavi-documents/supply-procurement/.
[ 7 ] http://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/
[ 8 ] See especially the Regional Summaries (1.) here: http://www.who.int/immunization/monitoring_surveillance/data/en/
[ 9 ] Pentavalent = diphtheria, tetanus, pertussis, hepatitis B, and Haemophilis influenzae type b (Hib) in a single shot. Just this week, an article was published describing a significant breakthrough in cold chain management: https://www.sciencedaily.com/releases/2016/07/160706092214.htm.