Since 1994, the U.S. Vaccines for Children (VFC) program has covered the cost of vaccines for children whose families might not otherwise be able to afford vaccines. This report assessed and quantified the health benefits and economic impact of routine U.S. childhood immunizations among both VFC-eligible and non–VFC-eligible children born during 1994–2023. Diphtheria and tetanus toxoids and acellular pertussis vaccine; Haemophilus influenzae type b conjugate vaccine; oral and inactivated poliovirus vaccines; measles, mumps, and rubella vaccine; hepatitis B vaccine; varicella vaccine; pneumococcal conjugate vaccine; hepatitis A vaccine; and rotavirus vaccine were included. Averted illnesses and deaths and associated costs over the lifetimes of 30 annual cohorts of children born during 1994–2023 were estimated using established economic models. Net savings were calculated from the payer and societal perspectives. Among approximately 117 million children born during 1994–2023, routine childhood vaccinations will have prevented approximately 508 million lifetime cases of illness, 32 million hospitalizations, and 1,129,000 deaths, at a net savings of $540 billion in direct costs and $2.7 trillion in societal costs. From both payer and societal perspectives, routine childhood vaccinations among children born during 1994–2023 resulted in substantial cost savings. Childhood immunizations continue to provide substantial health and economic benefits, while promoting health equity.
IntroductionImmunizations have contributed to substantial declines in morbidity and mortality associated with vaccine-preventable diseases worldwide. Broad availability of and access to vaccines is critical to averting disease and maximizing health benefits. In response to a U.S. measles resurgence during 1989–1991, the U.S. Congress established the Vaccines for Children (VFC) program in 1994 to provide vaccines at no cost to eligible children[1]. Children can receive vaccines through VFC if they are Medicaid-eligible, uninsured, underinsured,* or American Indian or Alaska Native[2]. In 2023, approximately 54% of children aged ≤18 years were eligible to receive VFC vaccines (CDC, unpublished data, 2023).
VFC has provided vaccines targeting nine diseases for eligible children aged ≤6 years since the program began in 1994: diphtheria, tetanus, and pertussis (DTP, [later, acellular pertussis, DTaP]) vaccine; Haemophilus influenzae type b (Hib) vaccine; polio (oral poliovirus vaccine [OPV] then inactivated [injectable] poliovirus vaccine [IPV]); measles, mumps, and rubella (MMR) vaccine; and hepatitis B (HepB) vaccine. Vaccines or immunizing agents targeting seven additional diseases were added to the routine immunization schedule for children aged ≤6 years† during 1996–2023: varicella vaccine (VAR; 1996); hepatitis A vaccine (HepA; 1996–1999 for high-risk areas and 2006 for all states); pneumococcal conjugate vaccine (PCV) (7-valent [PCV-7] in 2000, 13-valent [PCV-13] in 2010, 15-valent [PCV-15] in 2022, and 20-valent [PCV-20] in 2023); influenza (for children aged 6–23 months in 2004 and for those aged 6–59 months in 2006); rotavirus vaccine (Rota; 2006); COVID-19 vaccine (2023); and respiratory syncytial virus vaccine (RSV; 2023). This report summarizes the health benefits and economic effects of routine U.S. childhood immunization among all children (both VFC- and non–VFC-eligible) born during 1994–2023.
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