Vaccine Health Technology Assessment

Lord Kamall Excerpts

Thursday 8th January 2026 Grand Committee

[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.