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Health Aff (Millwood). 2016 Feb;35(2):199-207. doi: 10.1377/hlthaff.2015.1086.

Return On Investment From Childhood Immunization In Low- And Middle-Income Countries, 2011-20.

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Sachiko Ozawa ( is an assistant scientist in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland.
Samantha Clark is a research associate in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health.
Allison Portnoy is an SD candidate in the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, in Boston, Massachusetts.
Simrun Grewal is a PhD candidate in the Pharmaceutical Outcomes Research and Policy Program, University of Washington, in Seattle.
Logan Brenzel is a senior program officer for cost-effectiveness in vaccine delivery at the Bill & Melinda Gates Foundation in Washington, D.C.
Damian G. Walker is a deputy director for data and analytics in global development at the Bill & Melinda Gates Foundation in Seattle.


An analysis of return on investment can help policy makers support, optimize, and advocate for the expansion of immunization programs in the world's poorest countries. We assessed the return on investment associated with achieving projected coverage levels for vaccinations to prevent diseases related to ten antigens in ninety-four low- and middle-income countries during 2011-20, the Decade of Vaccines. We derived these estimates by using costs of vaccines, supply chains, and service delivery and their associated economic benefits. Based on the costs of illnesses averted, we estimated that projected immunizations will yield a net return about 16 times greater than costs over the decade (uncertainty range: 10-25). Using a full-income approach, which quantifies the value that people place on living longer and healthier lives, we found that net returns amounted to 44 times the costs (uncertainty range: 27-67). Across all antigens, net returns were greater than costs. But to realize the substantial positive return on investment from immunization programs, it is essential that governments and donors provide the requisite investments.


Developing World < International/global health studies; Health Economics; Health Spending; Maternal And Child Health; Public Health

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