Vaccines are often framed solely as a health intervention, but they are also a critical economic investment. This investment generates high returns in both the short and the long term. As I highlighted in my presentation this week at the World Vaccine Congress, vaccination prevents illness, reduces medical spending, preserves productivity, and protects families, employers, and health systems from avoidable disruption. That is true for childhood vaccines, adult immunizations, and emerging next-generation products, alike. The economic case for vaccines is not speculative. It is visible in avoided hospitalizations, fewer missed workdays, lower caregiver burden, and a more resilient workforce and health care system.

The illness and value statistics are especially striking for childhood immunization. Routine childhood immunizations in the United States from 1994 through 2023 are estimated to have prevented roughly 508 million illnesses, 32 million hospitalizations, and more than 1 million deaths. Those gains translated into approximately $540 billion in direct medical cost savings and nearly $2.7 trillion in total societal savings. Put simply, every $1 spent on childhood immunizations generated about $11 in savings. That is not merely a good return in health policy terms. It is the kind of return most sectors of the economy would gladly claim as a success.

But the value of vaccines extends well beyond the pediatric context. Adult vaccination also produces meaningful economic gains, particularly through reduced absenteeism, less presenteeism, and better labor-market continuity. Evidence suggests that adult immunization programs can return up to 19 times their initial investment. In a 2025 employer model for a 10,000-employee firm, a COVID workplace vaccination program at 70 percent coverage prevented more than 3,100 absent days and saved nearly $860,000 in lost productivity, in addition to direct medical savings. A comparable seasonal influenza program prevented approximately 1,700 absent days and generated hundreds of thousands of dollars in productivity and medical savings. Vaccination protects the worker, but it also protects staffing reliability, operational continuity, and employer output.

These economic and quality of life gains show why vaccine value should not be viewed only through a narrow health care lens. The real value stack is much larger. It includes direct medical costs avoided, non-medical costs avoided, productivity losses prevented, caregiver time preserved, outbreak-response costs avoided, and longer-run protection of human capital. Once illness becomes severe, the costs rise quickly. Adult influenza hospitalizations can cost roughly $11,000 to $14,500, while severe respiratory hospitalizations can generate total attributable costs approaching $68,000 when post-discharge spending is included. Vaccination is often inexpensive by comparison: Commercial reimbursement for vaccine administration averaged $25.80 for a first dose and $14.71 for additional doses in the same visit. This is why prevention remains such an economically efficient form of care.

There is also a morbid arithmetic to declining vaccination: Outbreaks are expensive. In Texas, a 2025 outbreak with 762 cases, 99 hospitalizations, and two deaths was estimated to result in roughly $35.4 million in total costs. Yet immunizing the same number of individuals with the full measles, mumps, and rubella (MMR) series would have cost only $40,264 through the Vaccines for Children program. In South Carolina, a 2025–2026 outbreak with 993 cases generated an estimated $35.5 million in costs, compared with $66,193 to vaccinate the same number of children through VFC. Those costs are only growing – the outbreak in South Carolina has not yet abated. These are not close calls. The cost of undervaccination can exceed the cost of prevention by orders of magnitude.

Still, none of this value is automatically realized. Vaccine access is a multi-step process: Vaccines must be approved, recommended, covered, accepted, and ultimately administered. If any one of those steps breaks down, the value chain weakens. That is why confidence and access matter so much. When public confidence in the childhood immunization schedule erodes, uptake risk rises. When coverage becomes less certain, or vaccination becomes harder to obtain, the economic returns diminish as well. Broad access is not a secondary issue tacked onto the back end of vaccine policy. It is the mechanism through which vaccine value is actually realized.

Even institutions that sit somewhat outside the usual coverage debate matter for access. The Vaccine Injury Compensation Program, for example, helps support stable vaccination development, manufacturing, and administration by providing a no-fault process for rare injury claims, reducing some of the legal and market uncertainty that historically threatened vaccine supply. That makes it part of the broader access architecture: not the centerpiece, but one of the supports that helps keep vaccines available and public confidence intact. A strong vaccine market expands the frontier of future value by supporting new platforms, better prevention, and continued innovation. A judicious vaccine policy therefore cannot focus only on innovation at the front end. It also has to protect the middle and back end of the process: recommendation, insurance coverage, financing, administration, confidence, and market stability.

The broader lesson is straightforward. Vaccines are value-based care in one of its clearest forms. They preserve health, safeguard productivity, support healthy aging, and reduce the financial spillovers that follow preventable disease. But those benefits only materialize at scale when access is broad, dependable, and sustained. If the goal is to capture the full economic value of vaccines, then expanding and protecting access is not peripheral to the mission. It is the mission.