(1 day, 19 hours ago)
Grand CommitteeRead Hansard Text Read Debate Ministerial Extracts
Baroness Ritchie of Downpatrick
To ask His Majesty’s Government what plans they have to include wider societal and economic benefits within the vaccine health technology assessment, rather than limiting evaluation solely to clinical outcomes.
Baroness Ritchie of Downpatrick (Lab)
My Lords, I was delighted to secure this debate as this is a subject of significant importance and one in which I have a close interest. Health and economic growth are rightly identified by the Government as two of their central priorities and they sit at the core of the NHS 10-year plan. Vaccines lie at the intersection of these ambitions, yet the way we currently assess their value does not reflect the full contribution they can make to either. Vaccines are among the most effective public health interventions ever developed. For more than two centuries, they have saved lives, reduced pressure on health services and enabled societies and economies to function. Yet, despite this well-established record, the health technology assessment of vaccines in England remains too narrow.
At present, vaccine assessment focuses predominantly on direct clinical outcomes and immediate health system costs. While these are clearly important, they do not capture the wider societal and economic benefits that vaccines deliver, benefits that are directly relevant to both national growth and the long-term sustainability of the NHS. Vaccines keep people in work and children in school, and they enable carers to care. They reduce absenteeism, protect productivity and help prevent avoidable demand on already-stretched NHS services. In doing so, they support economic growth and help deliver the Government’s ambition of a healthier, more productive population, as set out in the NHS 10-year health plan. This matters because vaccines are fundamentally different from many other health technologies. They prevent disease before it occurs, reduce transmission and generate benefits that extend well beyond individual patients. Assessing them through a narrow clinical lens risks undervaluing prevention and slowing access to innovations that could deliver long-term health and economic gains.
Recent evidence from the Office of Health Economics provides compelling data in this regard. Its latest report provides estimates of the annual burden associated with respiratory illnesses for four selected vaccination programmes from the NHS routine schedule, as well as the projected costs and savings associated with those vaccines. Despite the delivery of national vaccination programmes for these four disease areas, a significant burden of disease remains. The report shows the costs to the NHS and quantifies the broader socioeconomic impact of vaccines, specifically the impact that they can have on reducing the UK welfare budget and workplace absenteeism and increasing UK productivity—helping to support the Government’s priorities on health and growth.
Key findings include the fact that the cost to the NHS of treating the unprotected population for these four respiratory illnesses alone is £3.9 billion. The cost to the wider economy is £3.6 billion, making a total of £7.4 billion a year. At the same time, the UK spends only 1.07% of health expenditure and 0.1% of GDP to cover immunisation programmes in the national schedule. A 10% reduction in the current burden, through higher coverage with the same vaccine, a future vaccine with higher efficacy or improved effectiveness at the same coverage levels, or a combination of the two, could deliver significant benefits—£384 million in annual NHS savings and £356 million in lower productivity costs. These findings are undoubtedly compelling and reinforce the point that vaccines should be viewed not as a short-term cost but as a strategic investment with benefits that extend well beyond the health system.
The experience of the Covid-19 pandemic made this abundantly clear. Vaccines were not only a health intervention; they were essential to economic recovery, educational continuity and social stability. Yet our routine assessment frameworks have not fully embedded this lesson.
I say gently to my noble friend the Minister that if the Government are serious about delivering their growth agenda and the ambitions of the NHS 10-year health plan, prevention and vaccines in particular must be valued accordingly. That requires assessment frameworks that recognise long-term, cross-government benefits, not just short-term clinical outcomes. I thank the Minister for the recent response she gave to my Parliamentary Question on this issue.
I welcome the recent positive decision by NICE to revise its cost-effectiveness thresholds. This is an important and constructive step. However, with these revised thresholds, the current framework does not systematically include broader socioeconomic benefits. I therefore ask the Minister whether these changes will feed through to JCVI evaluations of vaccines and immunisation programmes.
Crucially, while changes to thresholds may improve flexibility at the margins, they do not address the more fundamental issue that vaccines are still assessed using methodologies that fail to capture their full, long-term societal and economic value. I therefore urge the Government to consider how vaccine health technology assessment can evolve, including clearer guidance on incorporating societal and economic impacts, improved alignments between NICE, JCVI and the NHS, and an explicit recognition that prevention requires a different evaluative approach from treatment.
In closing, I ask my noble friend the Minister whether His Majesty’s Government will commit to establishing an independent committee to evaluate this existing vaccine health technology assessment process. Such a review could assess whether current approaches are fit for purpose, consider international best practice and make recommendations on how wider societal and economic benefits can be appropriately and consistently incorporated.
This is not about lowering evidential standards; it is about measuring the right outcomes over the right time horizon in support of the Government’s priorities on health, growth and NHS sustainability. If we continue to undervalue vaccines, we risk missing one of the most effective tools available to improve population health, reduce pressure on the NHS and support long-term economic prosperity.
I look forward to the Minister’s response on how the Government intend to take this forward and the contributions of other noble Lords on this very important issue.
Lord Bethell (Con)
My Lords, the noble Baroness, Lady Ritchie, has just given an utterly compelling speech on the subject of the debate today. I do not want to repeat the points she has made; they are completely convincing. Instead, I want to build on her arguments from my experience as a Health Minister by addressing the question of why, despite broad rhetorical agreement from all corners of this Parliament, we are still struggling to implement sensible measures on our assessment frameworks, and to suggest a couple of measures, some of which the noble Baroness has already alluded to, for how we can move forward constructively. In this, I declare an interest as a trustee of the Royal Society for Public Health.
No one thinks that vaccines are a complete panacea for all the health problems we have in this country. But, although we have multifactorial issues around social care, workforce, primary care access and all kinds of problems, vaccine prevention is a very significant, very important and easily modifiable contributor to our nation’s health. It is one of the few levers we have to improve the human capital of this country, and we do well in this country with the vaccines we have—but my lord, we could do a lot better. We should be leaning in, especially since new vaccines, including cell therapies and gene therapies, are on the horizon for cancer, heart disease and even depression. If we take the limited laid-back approach of today, we simply will not take advantage of the technologies of tomorrow.
UKHSA data shows that vaccine-preventable infectious disease hospitalisations cost the NHS between £970 million and £1.5 billion annually in avoidable emergency admissions. In other words, that is in-year healthcare costs for our system and our taxpayers. I appreciate that these are not totally fungible savings that automatically release money for the rest of the system, but they represent important opportunities to reduce preventable suffering and free up capacity, so that it can be turned to other urgent needs. They should therefore be valued highly.
If the case for greater use of the vaccines we have is so obvious, why have we not changed? I want to engage very seriously with the legitimate concerns raised by NICE, JCVI and the DHSC. First, there is the consistency argument. DHSC’s 2018 CEMIPP consultation stated that,
“if changes to thresholds and time horizons are considered for vaccines, they should also be considered more broadly”.
That is absolutely right. The implication is that we cannot treat vaccines differently, and I agree with that strongly. We need to completely change our approach from top to bottom, across all medicines. The solution is not to keep undervaluing vaccines but to update methods for all preventive interventions. After all, Germany operates modified frameworks for preventive technologies and the WHO explicitly recommends this, so why not Britain? The DHSC’s attitude is: “Because we assess everything badly, we must continue to assess vaccines badly too”. Let us be more ambitious, embrace the opportunity and make sure that we are allocating resources thoughtfully for maximum impact across the piece.
Secondly, there is the NHS perspective argument. NICE’s 2013 methods guide required assessment
“from the perspective of the NHS and personal social services”
because considering broader benefits would favour technologies that are less efficient at improving health when non-health benefits are higher. You bet they would—that is the entire idea. It is the voters’ priority and the taxpayers’ priority. It is this Parliament’s stated mandate. It is also the Treasury’s concern, so let us do it. I fear that, in this instance, NICE is not constrained by methodology; it is just out of date and failing to remember who pays the bills. We will lose the voters’ confidence with this approach.
Thirdly, there is the methodological uncertainty argument. The Office for Health Economics noted in 2021:
“Recognising the broader value of vaccines … requires … advancements in data and methodological capabilities”
to avoid double counting. As the noble Baroness, Lady Ritchie, alluded to, we should absolutely be clear about the limitations of evidence for long-term population health investments. Some of the productivity and long-term effects I have described in this speech come from economic models, not from randomised trials. That is inevitable but, even taking this into account, I fear that we are completely off the pace here. WHO published comprehensive guidance in 2019, and I can point noble Lords to countless reliable models that demonstrate the value of vaccines. In this case, the UK is not constrained by some daunting methodological frontier; we are just too easily overwhelmed by distracting clinical standards and behind the methodological curve.
Fourthly and lastly, there is the equity argument. NICE and DHSC raised concerns that including productivity could bias allocation towards working-age populations and against older people. NICE’s concern about bias towards working-age populations reveals the problem: the organisation views human capital preservation as a bias rather than an objective. Every pound we invest in keeping a 45 year-old healthy returns a huge multiple that can fund care for a 75 year-old. These are not competing priorities; they are complementary. We must stop apologising for the fact that preventing a death at 55 delivers massively more economic value than preventing one at 85. That is not discrimination; it is demography and economics.
Pressure is mounting. The British Social Attitudes survey shows widespread consensus that the NHS must transform from a national sickness service to one that supports people to live healthy lives. Voters, taxpayers and patients are expecting better. In other words, this debate is a metaphor for a broader failure. Our healthcare system focuses on system maintenance rather than on capital preservation.
So I ask for four concrete commitments from the Minister: first, to commission NICE to develop a broader value assessment for vaccines and preventative interventions by April 2026, and in this I echo the suggestion of the noble Baroness, Lady Ritchie; secondly, to expand respiratory vaccination to all ages over 50, phased over three years, from April 2026, including flu, pneumococcal and shingles—I declare an interest here: I recently paid for my shingles vaccine; thirdly, to launch targeted MMR catch-up campaigns in London and the West Midlands, where we are massively behind the pace; and, fourthly, to mandate UKHSA to publish annual human capital impact assessments for all major vaccination programmes.
Our £220 billion healthcare system does not need more money for this. We need to shift spending from wasteful, late-stage and low-value crisis management into early-stage, high-value prevention. This requires some services to shrink—specifically, expensive emergency capacity that we have built to cope with preventable disease should instead focus on vaccines—and requires an investment that yields massive economic, societal and human capital benefits. I look forward to the Minister’s response.
Baroness Goudie (Lab)
My Lords, I thank my noble friend Lady Ritchie for arranging for us to have this debate today. It could not be at a more important time for us.
Vaccines are one of the clearest examples that we have of prevention working well. They stop illness before it starts, they reduce pressure on the National Health Service, and they protect the most vulnerable in our society, yet, when we assess their value, we tend to look at them through a very narrow lens. At present, vaccine health technology assessments focus primarily on clinical outcomes and direct health system costs. That matters, of course, but it is not the whole story. When we ignore the wider societal and economic effects of vaccination, we risk undervaluing one of the most effective public health tools we have. This matters particularly for women, children and carers.
I shall start with children. When children are vaccinated, they are less likely to fall ill, less likely to miss school and more likely to stay engaged in learning. School absence is not a trivial issue. We know from the Government and from OECD analysis that sustained absence affects educational attainment and long-term life chances. When illnesses disrupt schooling, that does not affect the child’s health in the short term but it can shape their future for the long term, and that affects the country as a whole, yet the benefits of vaccination in reducing school absence and protecting learning are rarely counted in formal assessments. These costs do not disappear; they simply fall elsewhere, on families, on schools and ultimately on society. Every child’s health should matter.
I turn to carers. When a child is ill, or when an older or disabled family member becomes unwell, someone steps in to care. In the UK, that someone is most often a woman—mothers, grandmothers, daughters, sisters. They take time off work and reduce their hours. Sometimes they have to leave the workforce altogether. That does not make a family happy, it does not help GDP and it does not really help the family. The Library briefing makes it clear that societal perspective on health technology assessment can include informal care and productivity effects. That is not radical—it is already recognised in economic evaluation guidance—but in practice these impacts are often excluded or treated as secondary.
If we do not account for the burden placed on carers, we are in effect saying that their time, labour and lost income do not count. This is not gender neutral; it entrenches inequality by hiding costs that fall disproportionately on women and their pensions. Vaccination reduces that burden. It helps families to function and prevents crises in households that are already under strain. Those are real benefits, even if they do not show up immediately in the national health balance sheet.
There is also an important equality dimension. We know that vaccination uptake is not equal across communities; in some areas and groups in England, childhood vaccination rates have fallen and inequalities have widened. When preventable illness occurs, the social and economic consequences are felt most sharply in the communities that already face disadvantage. We must work hard to encourage families in those communities that vaccinations are safe overall and that it is the right thing to do. At the same time, we must not be too pushy; we have to work out the right way to encourage this across friends and across communities, as we did during the Covid situation. We worked very hard on that in this House. One of the leaders, who was a Muslim, very much helped us to do that and we need to look at that kind of work again.
This is not a fringe argument. The World Health Organization defines health technology assessment as
“covering both … direct and indirect consequences”
of health interventions. Academic work has repeatedly shown that vaccinations generate broader societal value, including educational benefits, productivity gains and protection against inequality. NICE already allows for analysis beyond the standard reference case when appropriate. The tools exist; what is missing is consistency and clarity about how and when wider societal benefits should be included for vaccines.
I want to acknowledge that there are challenges here. Measuring wider impacts is complex. There are legitimate concerns about double-counting and about privileging economic productivity over other values, but complexity is not a reason to ignore large and predictable effects; it is a reason to be transparent, to publish assumptions and to use sensitivity in all analysis. It is precisely because of those concerns that we must ensure equality and caregiver impacts are explicitly considered, not sidelined. If we count only what happens inside the clinic, we miss what happens in homes, in schools and in carers’ lives. Vaccines do not just prevent disease, they prevent disruption, inequality and unnecessary strains on families and workplaces. If we are serious about prevention, fairness and long-term guidance, our assessment frameworks need to reflect the world as it actually is.
Lord Rennard (LD)
My Lords, some weeks ago, the noble Baroness, Lady Ritchie of Downpatrick, tabled a Written Question on this subject. With great respect to the Minister, her response was not a strong one: it merely suggested the possibility of considerations such as productivity costs being highlighted by the Joint Committee on Vaccination and Immunisation, so we are all grateful to the noble Baroness for securing this debate and enabling us to take up the issue further.
I believe that considerations such as impact on productivity and the wider economy should always be included at the heart of decision-making concerning the provision of medicines and vaccines, but there is a general problem in public policy-making, with too much short-termism and insufficient weight being applied to factors beyond simple clinical outcomes. I often argue in the House that productivity, which was discussed in the Chamber yesterday, as well as wider socio-economic considerations, should be applied more generally to decisions about procurement in the healthcare sector. We need to consider these issues in relation to the provision of assistive technology supporting people with disabilities and we need to apply them to the provision of medical equipment, such as continuous glucose monitors and insulin pumps for people with diabetes.
In many public policy areas—not just healthcare—we need real, long-term cultural change. We need much less short-termism and much less policy development based on silos that exclude the consideration of wider relevant issues. Long-term benefit analysis concerning vaccinations must cover not just costs to the NHS against improving life expectancy but the benefits of a healthier workforce, of more people paying into HMRC and of fewer people with illnesses and disabilities being more dependent on the DWP. We should also look much more at the considerable potential benefits of greater emotional well-being to both people and society as a whole.
However, first, we must think ourselves lucky to live in the United Kingdom and not in the United States, where a dangerous, ignorant and prejudiced man was appointed by President Trump to undermine sensible public health policies with his anti-vax agenda. Millions of people worldwide are at risk because of his prejudices, which contradict the scientific evidence. I hope that the Minister will assure us that the Government are doing everything they can to prevent right-wing nutters in this country—many of whom are influenced by the far right in America—spreading dangerous disinformation here about the safety and necessity of vaccination programmes. Everyone should know that vaccinations prevent millions of deaths every year from diseases such as measles, rubella, polio, flu and Covid-19. We need to educate people from an early age against the prejudice of ideologies that are hostile to vaccinations.
We also need to look carefully at the current evaluation process for new medicines and vaccines, led by NICE and the JCVI, which is built on something that is too narrow and is termed the “health sector perspective”. This approach is about managing the immediate budgets of the NHS, but it is not about the budgets of the NHS in decades to come. This approach does not look at the economic consequences of inaction. Recent research from the Office of Health Economics suggests that respiratory infections alone cost UK businesses an estimated £44 billion annually in lost productivity. This is a drain on our national prosperity; productivity should be a key factor in considering the evaluation and rolling out of vaccines.
Last year, I got my flu jab. As a person with diabetes, I also got my Covid-19 jab on the NHS. However, this year, I was told that I no longer qualified for the Covid-19 jab. I had to pay £90 to have it privately, but not everyone can do that. Failing to vaccinate as widely as we should for flu and Covid-19 costs money in many ways. I understand that the prevalence of flu this year has been very damaging to the public sector and that many people will be badly affected by this. We also need to consider the impact of vaccination programmes on educational attainment. For childhood vaccines, the current models of evaluation often miss the long-term benefits of improved school attendance and cognitive performance, which eventually translate into higher lifetime productivity.
We need to look more at the benefits of vaccines that can make other life-saving treatments, such as chemotherapy for the immunocompromised, safer and more effective. We need to be more aware of antimicrobial resistance, or AMR. Vaccines are front-line defences in this battle, reducing the need for antibiotics and thus slowing the development of resistant strains. Although the JCVI acknowledges this, it does not yet consistently capture the value in its cost-effectiveness models.
The Government’s 10-year health plan and Life Sciences Sector Plan set an ambitious target: for the UK to be one of the top three fastest places in Europe for patient access to medicines by 2030. I know that there will always be pressure within government to prioritise measures that show benefit by the time of the next election. There is always intense pressure from the Treasury to consider the implications for immediate budgets and, as we know, whichever party wins the election, the Treasury stays in power. I believe that, to establish better practice, we should look more to nations such as Sweden, which already incorporates a broader range of studied impacts, including productivity losses for both patients and carers, in its assessments. I hope that the Minister can respond positively.
Lord Kamall (Con)
My Lords, I thank the noble Baroness, Lady Ritchie of Downpatrick, for securing this timely and important debate and for the eloquent way in which she laid out her argument. We saw the value of vaccines during the Covid-19 pandemic. Millions of people rolled up their sleeves, with the impact not just on patients and hospitals but on the wider economy. I thank my noble friend Lord Bethell, who was a Minister during that time, given some of the challenges Ministers faced in making sure that we found the vaccine solution and then were able to roll it out. That rollout was a turning point that allowed restrictions to be lifted and our country to try to get back to normal, but we know that we are still feeling the effects in some places, and some people are still feeling them.
When respiratory illnesses such as flu and Covid strike, people are forced to stay off work and children miss school. I thoroughly recommend the excellent briefing by the House of Lords Library; in fact, I may well use it in my teaching. At this point, I probably should declare my interest. I am a professor of politics and international relations at St Mary’s University in Twickenham, and I will be teaching an MBA module on healthcare policy and strategy this semester. The excellent Library briefing quotes the Office of Health Economics, which estimates that such absences cost employers around £850 per employee annually. As the noble Lord, Lord Rennard, said, that amounts to about £44 billion across the UK.
The Royal College of Paediatrics and Child Health suggests that reducing vaccine-preventable illnesses helps children to stay in school more consistently, improves access to education and supports better educational outcomes overall, as the noble Baroness, Lady Goudie, alluded to. In the Lancet, Professor Philippe Beutels wrote about the “peace of mind” that vaccination can bring, particularly for the clinically vulnerable. Knowing that you or your loved ones are protected matters enormously, yet this assurance is often overlooked in formal evaluations.
But there is a challenge. Taking account of wider societal and economic benefits within the current health technology assessments is not straightforward and is often subjective. We should also be aware of any unintended consequences, whether for healthcare budgets or for the cost of vaccine development. We will have read of the example of Portugal, when the argument was that it increased productivity so the pharmaceutical company said, “In that case, you can pay more for the vaccines given the wider societal impact”.
At the moment, vaccines are assessed in a more focused way. NICE and the Joint Committee on Vaccination and Immunisation largely operate from what is known as a health sector perspective. Health technology assessments focus on the direct impacts on the healthcare system, with wider societal and economic effects considered only in exceptional cases. NICE’s economic evaluations usually look only at the cost to the NHS and care services. While savings within the health system, such as short hospital stays, can be counted, the wider impacts such as productivity or keeping people in work are explicitly left out. The case for capturing some of these wider benefits within health merits careful consideration, as my noble friend Lord Bethell laid out.
While recognising concerns about broadening the criteria and the unintended negative consequences, as in the Portuguese example, there is also a practical challenge. We simply do not have enough good-quality data on the wider social and economic impacts of vaccines. As an academic I know, and others will know, that the quality of data really matters. You can make whatever argument you want if you have data that is too subjective or if it is contested, but neither is that an argument not to contest the data or some of the theories that come out. This is hardly surprising, given that these impacts are not currently captured as part of the health technology assessment and there is no agreed way of measuring these wider effects. Estimating the socioeconomic impact is inherently difficult, particularly for complex areas such as the role that vaccines play in reducing AMR, for example, or even putting a value on unpaid work, such as caring for family members. Once again, the noble Baroness, Lady Goudie, mentioned this.
There are and will be debates over what should be included and how; whether and how different factors should be weighted; and how far across society and the economy we should go. On many of these points, scientific consensus would be difficult. In measuring these effects, there will also be a challenge in ensuring that the data collected is robust and reliable. Achieving data of sufficient quality and certainty is itself a challenge.
The Office of Health Economics pointed out the siloed nature of public sector budgets, as the noble Lord, Lord Rennard, mentioned. This leads to a focus on clinical outcomes and healthcare alone. NICE has asked why, if health technology assessments were expanded to take account of the impacts on other sectors, those other sectors should not also routinely assess the health impacts of their own policies. Without that wider responsibility, there is a risk of the burden all falling on NICE or on the health part of government, when it is actually a wider societal gain. Finally, considering the broader challenge set out by the noble Baroness, Lady Ritchie, we should recall that in 2022 the NICE review judged that expanding this work further
“would be disproportionate to any expected benefits to the quality of NICE decisions”
given the flexibility that already exists to take “relevant wider effects” into account.
It is clear that this debate is important but also on a balanced issue. It raises serious questions about the wider benefits of vaccination, not always considered by current health technology assessments, but also exposes some of the methodological and resource challenges. This should not be an excuse for a lack of action or for not investigating these ideas in more detail.
One crucial point should not be overlooked: the benefits debated today, economic, social and clinical, can be realised only if people actually get vaccinated in the first place. I was concerned, as I am sure the Minister was, to see that by the end of week 50 of 2025, only 36% of pregnant women and only 39% of under-65s in clinical risk groups had received the flu vaccine. Within the NHS, as of late October—I hope that the Minister has more up-to-date figures—fewer than three in 10 nurses working in secondary care had received the flu vaccine. This sends the wrong message to patients but also puts patients’ health, and even lives, at risk. Given the concerns over the flu outbreak this winter, we should consider why these vaccination rates are so low.
I really want to ask the Government about their strategy, so I shall end by asking some quick questions. Can the Minister explain why the vaccination rates are so low? What are the primary reasons? Is it about communications, access or convenience? What assessment has been made of each of these factors? What assessment has the Department of Health and Social Care made of the wider benefits of achieving high vaccination coverage, especially among school-age children? We know that this can be a sensitive topic at times, but has the department considered the broader societal and educational impacts?
Can the Minister also set out whether any work is under way within the department to ensure that the wider assessments we have debated today are carried out more regularly? Has it looked into that in more detail? Given that the NICE 2022 review concluded that the current system already has sufficient flexibility to consider wider impacts on an ad-hoc basis, is the Minister aware of whether such assessments have been used more regularly since then, and does the department judge them to be a helpful and effective part of decision-making? These are really important questions that I think we need answers to, but I close again by thanking the noble Baroness, Lady Ritchie of Downpatrick, and all noble Lords who contributed today. I also thank the Minister in advance for her response.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I am most grateful to my noble friend Lady Ritchie for her thorough introduction and for securing this debate. I am also grateful to all noble Lords for their considered contributions. The subject of today’s debate reflects my noble friend’s steadfast commitment to improving access to immunisation and her tireless efforts to ensure that vaccination matters continue to receive the attention that they undoubtedly deserve. As the noble Lord, Lord Kamall, said, this is a very important debate to have and I welcome the probing that it provides.
Let me say at the outset that I believe we in the UK can be proud that we have one of the most extensive vaccination programmes in the world. We protect people across their life course and it is underpinned by rigorous scientific evidence and a commitment to equitable access—a point made both by the noble Lord, Lord Kamall, and my noble friend Lady Goudie.
The question of international comparators was raised. Our vaccination progress serves as a global benchmark for innovation and best practice, and many nations look to align their immunisation schedule with ours.
I will focus on the specifics as best I can in the time available. On the JCVI, the noble Lord, Lord Bethell, made a number of comments suggesting what I might say, and in a number of cases he will be entirely right, so I am grateful to him for shining a light on some of those points. Decisions on introducing or changing vaccination programmes are informed by advice from the Joint Committee on Vaccination and Immunisation. It is an independent and expert committee and world leader in this field, as has been recognised in this debate. It bases its advice on high-quality data, disease burden, vaccine safety and efficacy, and the impact and cost-effectiveness of programmes, and it ensures that we maintain public confidence in our policies. I know that all these things are important to noble Lords.
On the current approach to evaluating vaccines, the cost effectiveness analysis used by the JCVI compares the cost of a vaccine relative to the health benefits it provides. I appreciate that this debate is about extending beyond that, but that is what it does. It looks at the health benefits provided for a vaccinated individual and others—this point was raised in the course of the debate—and it considers direct cost savings to the health and social care system resulting from immunisation, such as averting hospitalisation and the need for social care.
My noble friend Lady Ritchie suggested that the current approach somehow undervalues prevention, can delay innovation and does not take into account benefits beyond those to the individual patient. I would put this rather differently to my noble friend, because the methodology is entirely focused on prevention. As I mentioned, the positive benefits are not just for the person who has been vaccinated but for those around them. We look to reduce the incidence of infection, and we are also mindful about the transmission of conditions and infections to others.
My noble friend also asked about changes to thresholds. I can say to her that we are actively considering the impact of changes to thresholds in vaccination programmes. Perhaps I will only be a little cautious, but there is the potential that such a change would increase the costs of existing programmes, perhaps by incentivising higher prices from suppliers. But there is a recognition of the role that such a change could play in encouraging innovation, and I know that my noble friend is very keen to see that.
I am not sure this came up too much in the debate, but it is an important point. Our use of data to establish cost effectiveness has ensured that we get value for money from manufacturers, and that has allowed us to deliver a comprehensive programme. It is important that we continue to keep that value for money.
On wider societal and economic impacts, it is the case that wider benefits can be highlighted by officials or the JCVI when advising government on vaccination programmes, but it is also true that it does not account for the impact of vaccination that I have heard all noble Lords call for. A key reason for this—the noble Lord, Lord Bethell, pre-empted this—is that the wider benefits cannot be quantified consistently across all vaccination programmes. There is currently a lack of available high-quality data on socioeconomic benefits. As the noble Lord said, robust data may be available for very few programmes. Basing decisions on wider benefits would create disparities whereby vaccination programmes with high-quality data and wider benefits were considered more valuable. So we do not have the basic situation to achieve what we all want.
There are also many uncertainties when modelling socioeconomic benefits. Unpaid care was mentioned, for example; I think my noble friend Lady Goudie referred to it. Quantifying the impact on that would be extremely complicated, and there is no clarity on how estimating or modelling this or other impacts should be approached. That concern was echoed by NICE when it did an appraisal on this very topic in 2022, and it agreed to maintain the approach that it currently takes.
On the point about supply that I mentioned earlier, there can also be a risk that by adding wider benefits into formal evaluation methods we send a signal to suppliers that we could be open to paying higher costs for the same vaccines or medicines. I see noble Lords both nodding and shaking their heads, which is the purpose of a debate.
There are additional ethical concerns. As was mentioned, vaccination programmes for working populations, important though they are, could be preferred over programmes for those who are not economically active. That is not a basis on which we would want to proceed because it would exacerbate inequalities and undermine the equity of our approach.
I recognise that my noble friend Lady Ritchie has raised this Question as part of a focus to broaden vaccination access. That is a goal to which we are absolutely committed. We have been putting plans into action to provide new programmes—for example, launching programmes to protect infants and older adults against RSV. Just this month, we announced that a vaccine against chickenpox would go into the routine childhood immunisation schedule. That is expected to save the NHS some £15 million a year in costs for treating vaccinations.
The important matter of improving uptake has been raised. We are delivering vaccinations in new ways via community pharmacists, and pilots for administering vaccinations within health visits are starting this month. Through this targeted outreach, we offer an opportunity to increase uptake and reduce inequalities by providing vaccinations to those who might not otherwise access vaccinations. We are also working with healthcare professionals so that they can confidently discuss immunisation with concerned patients, because it is vital to tackle vaccine information. We are exploring innovative delivery models and delivering trusted messaging, to take up the point made by the noble Lord, Lord Rennard, who spoke about other influences that we would not welcome.
A number of questions have been asked, and I will be glad to write to noble Lords to pick up their specific points. I realise that my remarks in general will not be the ones that my noble friend and other noble Lords will have hoped for, but I hope I have been able to outline some of the difficulties while appreciating the points that have been made.
Baroness Ritchie of Downpatrick (Lab)
Before my noble friend sits down, I ask that she and her ministerial colleagues in the Department of Health and Social Care give particular attention to establishing the independent committee to evaluate the existing vaccine health technology assessment process so that the impact of vaccines on the economy, education and wider society can be seen clearly.
Baroness Merron (Lab)
I understand why my noble friend is raising that, but NICE is seen as a world leader in that regard and has processes in place to review its processes and methods to ensure that they remain fit for purpose. I am not entirely convinced, as my noble friend will see, that we need to establish an independent committee, but doubtless she will pick up this point, and I will be pleased to hear from her further on it.