Global, regional, and national impact of the Expanded Programme on Immunization against 14 pathogens from 1974 to 2024: an economic evaluation

This peer-reviewed article in The Lancet Global Health presents a global economic evaluation of the Expanded Programme on Immunization over its first 50 years, from 1974 to 2024. The study estimates benefit-cost ratios and incremental cost-effectiveness ratios for immunization against 14 pathogens across 194 WHO Member States, comparing observed EPI implementation with a counterfactual scenario of no vaccination. The analysis was conducted from a societal perspective and included vaccine procurement, administration, and family additional costs, with benefits measured primarily through averted lifetime productivity losses from mortality. 

Key findings

• From 1974 to 2024, EPI costs were estimated at US$937 billion, while averted productivity losses due to mortality reached US$15.05 trillion, yielding a global benefit-cost ratio of 16.06.
• Across all 194 WHO Member States, immunization against the 14 pathogens was cost-saving overall, with benefit-cost ratios greater than 1 in every country.
• Measles vaccination generated the highest economic returns, with a benefit-cost ratio of 73.97 and US$12.84 trillion in averted productivity losses.
• Low-income countries had the highest benefit-cost ratio at 23.63, followed by lower-middle-income countries at 16.58.
• Although benefit-cost ratios declined over time, EPI continued to generate substantial returns, with a global benefit-cost ratio of 7.53 for 2000–2024 and 4.89 in 2024.

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