Vaccines return $16 for every $1 invested, but the era of dramatic cost savings may be fading

Summary This global economic modeling study evaluated 50 years (1974–2024) of the WHO Expanded Programme on Immunization (EPI) across 194 WHO member states and 14 pathogens, using a societal-perspective cost model and human-capital approach to quantify averted lifetime productivity losses from mortality. Total EPI cost was $937 billion (95% CI 699–1187), averting an estimated 154 million deaths and $15,050 billion (12,609–17,605) in productivity losses, yielding a global benefit-cost ratio (BCR) of 16.06 (10.62–25.20) and ROI of 15.06. Measles vaccination drove the largest benefit (BCR 73.97), while low-income countries showed the highest regional BCR (23.63); all pathogens’ ICERs fell below cost-effectiveness thresholds, though global BCR declined over time, from historical highs to 4.89 in 2024 alone. Comment: One may argue:  Impressive headline number, but the declining BCR trend (16 overall vs. 4.89 in 2024) is the real story and gets buried—rising vaccine/administration costs and shrinking marginal returns as coverage plateaus deserve more attention than...