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This article was published 20/10/2017 (1021 days ago), so information in it may no longer be current.
The flu season is upon us, and Manitoba Health has started its annual campaign to encourage everyone to get the flu shot.
This year, the H3N2 flu strain appears to be dominant; it’s also known as the "Aussie" flu because Australia is now recovering from its worst outbreak of flu in many years. Public health officials in the northern hemisphere worry that low rates of immunization will see that experience replicated in Canada, the United States and Europe this winter.
Most of us see vaccination solely as a health issue. However, vaccination to prevent disease has major economic benefits.
To understand this, let’s travel back to the late 1960s, when the Vietnam War was ensnaring the U.S. in a deepening quagmire. Congress was eager to identify areas to "defund" and latched upon cancelling measles immunizations as having potential to find money for the war.
In a landmark study published in 1969, Norman Axnick, Steven Shavell and John Witte examined the benefits and costs of measles vaccination. Their methodology illustrates how economists have come to measure the economic value of vaccination.
Offsetting the direct costs of immunization (the cost of the measles vaccine and its delivery to the public) are three important benefits. The first and most obvious is avoiding the loss of school days by sick children and the loss of work experienced by caregivers (parents).
Second are the costs of caring for the small number of children who contract encephalitis, a relatively rare consequence of measles. Although these numbers may be small, the costs can mount rapidly since some of the affected children will become vegetative and require lifetime care.
Third, and most significant, are the lifetime losses incurred because those few children who die deprive the economy of their contribution. Added to this is the loss to the economy of those who can never work. In both cases, since children might have the potential for 35 to 40 years of paid work, the losses to the economy are simply the total of their expected incomes over their lifetimes.
Axnick and his colleagues found that the direct costs (in 1969 dollars) of the measles vaccination program amounted to about US$108 million; however, the three losses associated with cancelling the vaccine program would trigger US$531 million in lost productivity. Congress quickly shelved any plan to cancel measles vaccination.
Research on the value of flu vaccination shows similar benefits. Recent studies estimate the costs (direct costs and productivity losses) of flu to the U.S. economy at between US$50 billion and US$90 billion, which equates to around US$5 billion for the Canadian economy and US$300 million to the Manitoba economy.
So why, in the face of this evidence, are immunization rates so low?
Studies on how the Manitoba public views the flu vaccine last year reveal that most simply did not get around to it (37 per cent), others do not think they need it (28 per cent) and still others have concerns about adverse reactions (18 per cent), or do not think vaccinations work (13 per cent).
Most of this inaction reflects information failure because the public health system cannot overcome the natural inertia we all have. It also results from the active promotion of myths by the anti-vax lobby.
The fabrication by Andrew Wakefield in 1998 of a relationship between the vaccine for measles, mumps, and rubella (MMR) and childhood autism was a notorious example of such a myth. This link has been completely debunked, and Wakefield has lost his medical licence; yet it remains a touchstone for those determined to see vaccination as a plot by "big pharma."
Sometimes a new vaccine is premature. For example, when it first developed the vaccine for HPV (human papillomavirus), Pfizer actively promoted its administration to girls aged 12 as a strong protection against cervical cancer. The low incidence of cervical cancer and the need to administer the vaccine before females become sexually active created hesitancy among parents. Health economists also had trouble reconciling the cost (US$300 per dose) with the benefits that would accrue to so few later in life.
But research advances. HPV, the first virus to the linked to a specific cancer, is now believed to cause other cancers (throat and neck) in both men and women. It is also associated with other unpleasant conditions such as genital warts. The health and economic case for administering HPV vaccine to both boys and girls has become much stronger, and now several provinces offer this immunization for children starting as early as the fourth grade.
My students seem to think they are superheroes from a Marvel comic and that they are immortal. Very few will get the flu shot. I told them getting the flu over the winter break is an inconvenience, but getting the flu two weeks earlier — when they are writing their final exams — can affect their performance, lower their GPA and alter their lifetime earnings. It seems a "no-brainer" to spend 10 minutes in a pharmacy receiving a free vaccine that lowers that risk.
Gregory Mason is an associate professor in the department of economics at the University of Manitoba.
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