Vaccines are often likened to a seatbelt or an emergency brake in a car—interventions we might forget are there until they’re urgently needed. In public health, they represent one of the most powerful tools to prevent disease and promote wellbeing. And yet, within our current systems of health technology assessment (HTA), the full value of vaccines is not always adequately captured. As someone who has spent years researching economic evaluations in global health, I’ve come to believe that our existing models—while robust in many ways—need to evolve to reflect the broader societal, economic, and equity impacts of immunisation.

One of the most common misconceptions is that health economics is about reducing costs. Instead, health economics is actually about making the most of limited resources to generate the greatest possible health gains. The principle of scarcity (and therefore opportunity costs) underpins everything we do—whether that’s in hospital beds, specialist time, or federal budgets. In that context, economic evaluations like cost-effectiveness analysis are used to help decision-makers understand trade-offs: if resources are used to fund one intervention, those resources cannot be used for something else. These models typically calculate cost per quality-adjusted life year (QALY) gained, offering a way to compare diverse health interventions on a level playing field.

Vaccines consistently rank among the highest-value interventions across global analyses. Their ability to prevent illness, reduce healthcare use, and improve population health outcomes is well established. However, many of these benefits—particularly long-term ones—are discounted in traditional models. Australia, for instance, uses a 5% annual discount rate for both health benefits and costs, higher than many comparable countries. This has a significant effect on preventive interventions like vaccines or screening interventions, where costs often occur up front, but the benefits often accrue years or decades after administration.

The recent Health Technology Assessment (HTA) Review in Australia offers an opportunity to rethink this. Among its many recommendations, the review considered whether discount rates should be revised in line with other economies similar to our own[NC1] , potentially moving towards the 3.5% figure used by the Pharmaceutical Benefits Advisory Committee (PBAC) in special cases—such as the listing of the meningococcal B vaccine for Indigenous children. That change alone could make a measurable difference in how we assess and fund vaccines with lifelong benefits. It’s important, however, that we maintain consistent methodology for assessing the cost-effectiveness of all interventions, whether they are vaccines, therapeutic medicines, or other health technologies.

Beyond technical adjustments, a more fundamental shift is needed in how we define value. Traditional economic models focus on health outcomes and direct medical costs, but vaccines offer benefits that ripple far beyond the individual. These include reduced transmission of infectious diseases to others, economic resilience, improved mental health, protection of vulnerable populations, and even mitigation of antimicrobial resistance. During the COVID-19 pandemic, we witnessed firsthand how vaccines helped reopen economies, restore education, and reconnect families. Yet these outcomes are rarely incorporated into HTA submissions in a structured way.

Globally, there's a growing movement to formalise broader value frameworks for vaccines. The ISPOR “value flower” is one such model, expanding the traditional cost-per-QALY approach to include elements like equity impacts, broader societal impact, and disease prevention. All else being equal – costs and health benefits, an intervention that also reduces inequities in society, should be prioritised over one that maintains existing, unfair gaps in health outcomes. Closer to home, Indigenous models of health—which emphasise community, culture, and collective wellbeing—offer compelling perspectives that could enrich how we value interventions in Australia.

Encouragingly, the HTA review acknowledged the need for more structured horizon scanning, better integration of real-world data, and greater stakeholder engagement. It also recognised that the vaccine evaluation process is often more complex and slower than that for medicines, with multiple steps from TGA registration through ATAGI and PBAC assessments before inclusion on the National Immunisation Program (NIP). Streamlining this pathway could reduce delays in access by years. There is also a need for better understanding of methodologies that can be used to model infectious diseases, including dynamic modelling approaches, that are sometimes needed to evaluate the cost-effectiveness of vaccines when indirect effects, such as herd immunity, are important to capture.

Ultimately, valuing vaccines more accurately isn't just a technical challenge—it’s an ethical imperative. By recognising their full impact, we can make better decisions not just for individual patients, but for communities and future generations. As researchers, clinicians, policymakers, and advocates, we all have a role to play in shaping an HTA system that captures what truly matters.