THE PROBLEM

Vaccinating adults, and especially the elderly, has long been overlooked despite the success of vaccines in dramatically reducing child morbidity and mortality around the world over the past three decades. Vaccine-preventable diseases remain a significant cause of death among adults ages 65 and older, and despite rapidly aging populations and the availability of multiple newly licensed adult vaccines (for example against pneumococcal disease, RSV, and herpes zoster), large gaps in immunization coverage remain among older adults. These gaps are particularly pronounced in low- and middle-income countries but even persist in high-income countries. A key barrier to progress is the limited availability of evidence on the economic benefits and costs of adult vaccination that could help to inform policy and investment decisions for adult vaccination. At the same time, it is important to identify the conditions—including the burden of vaccine-preventable disease, the price of vaccines, and the cost of immunization—that might make adult vaccination economically attractive in some countries but unattractive in others.

THE PHAROS SOLUTION

The Coalition for Epidemic Preparedness and Innovation (CEPI) and Bill and Melinda Gates Foundation engaged Pharos to evaluate the economic attractiveness of adult vaccination globally. We developed and applied a modeling framework to be used by health analysts for informing government officials as they consider whether to invest in adult immunization. It also points to the required improvements in vaccine efficacy resulting from R&D investments, as well as the lower prices that would need to be realized through pooled procurement, in order to make the adult vaccines economically attractive.

The resulting paper, The Economic Value of Routine Adult Vaccination: A Global Modeling Positioning Assessment:

• Estimates benefit–cost ratios for five major adult vaccines (seasonal influenza, pneumococcal, RSV, herpes zoster, and COVID-19) across age groups and country income settings, including Low Income, Lower Middle Income, Upper Middle Income, and High Income Countries.
• Provides a practical tool for national analysts and policymakers to determine which vaccines merit deeper assessment and, ultimately, public financing from an economic perspective.
• Enables exploration of vaccine price and delivery cost thresholds and levels of improved vaccine efficacy that countries must achieve to consider an adult vaccine as an economically attractive investment. Such price reductions could be achieved through technological advances, large-scale manufacturing, and procurement negotiations.

The paper finds that routine adult vaccination against influenza appears to be economically attractive in elderly groups in most country income groups, including in low income settings. Pneumococcal vaccination also generates high benefit-cost ratios in older populations across several country income groups. RSV is currently less attractive, because of lower reported disease burden and high cost of the vaccine. Herpes zoster has unattractive benefit cost ratios based purely on mortality reduction, but the resulting reduction in illness, pain, and suffering from infection as well as possible prevention effects on other co-morbidities, such as elderly dementia, may generate significant benefits that justify vaccination. The paper therefore concludes that countries may currently be failing to prioritize or invest adequately in policies, programs, and delivery platforms for routine adult vaccination.

LOOKING AHEAD

The results of our modeling analysis can serve to broadly position the five adult vaccines across age and country income groupings and are meant to assist national analysts and policy makers to look deeper into the economic value of adult vaccination at a country level. These methods have been applied in a country case study for Norway in collaboration with the Norwegian Institute of Public Health (NIPH).

Status: Completed December 2025

Team Members Involved: Jeremy Otridge, Alyssa Agarwal, Dean Jamison, Mariam Mubarak-Gabrian, and Robert Hecht.