Vaccine Health Technology Assessment

Baroness Ritchie of Downpatrick Excerpts

Thursday 8th January 2026 Grand Committee

Asked by

[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.

--- Later in debate ---

[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.