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Med Decis Making. 2003 Jan-Feb;23(1):76-82.

Economic evaluation of vaccination programs: the impact of herd-immunity.

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Immunisation Division, PHLS Communicable Disease Surveillance Centre, London NW9 5EQ, UK.


The unique characteristic of vaccination is that it not only reduces the incidence of disease in those immunized but also indirectly protects nonvaccinated susceptibles against infection (produces herd-immunity). The bulk of economic evaluations of vaccination programs continue to use models that cannot take into account the indirect effects produced by herd-immunity. Here, the authors illustrate the importance of incorporating herd-immunity externalities when assessing the cost-effectiveness of vaccination progams. To do this, they compare 2 methods of estimating the benefits of routine mass vaccination: one that includes herd-immunity (dynamic approach) and one that does not (static approach). Finally, they use the results to clarify a number of misconceptions that are common in the literature concerning herd-immunity and dynamical effects produced by models.

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