Vaccine Health Technology Assessment

Baroness Goudie Excerpts

Thursday 8th January 2026 Grand Committee

[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.