Vaccine Health Technology Assessment

Lord Bethell Excerpts

Thursday 8th January 2026 Grand Committee

[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.