Question to the Department of Health and Social Care:

To ask His Majesty's Government what evidence, analysis or expert advice Ministers relied on in concluding that broadening the scope of health technology assessments for vaccines to include wider economic and societal impacts is unnecessary; and whether this conclusion was informed by any assessment of the capability and remit of the National Institute of Health and Clinical Excellence and the Joint Committee on Vaccination and Immunisation in areas beyond pure health system cost-effectiveness, such as macro-economics, public finance, and social and welfare analysis.

We are proud to have one of the most comprehensive vaccination programmes in the world. Our approach to evaluating vaccination programmes, underpinned by recommendations and advice from the Joint Committee on Vaccination and Immunisation (JCVI), is grounded in rigorous and evidence-led cost-effectiveness analysis, and ensures that decisions are objective, consistent, and based on high-quality data on health benefits and costs.

Basing our approach on these factors avoids the uncertainty of less direct benefits, where the evidence and therefore the decision is likely to be less defensible. This approach is also informed by previous work on this topic.

For example, earlier work by the independent Cost-Effectiveness Methodology for Immunisation Programmes and Procurement (CEMIPP) considered, amongst other things, whether wider socio-economic impacts should be included in the framework used to assess the cost-effectiveness of vaccines. CEMIPP conducted a consultation as part of their wider work and drew upon a broad body of expert opinion. The group concluded that wider socio-economic impacts should not be included in vaccine cost-effectiveness assessments unless doing so becomes standard practice across all health technology assessments.

Additionally, in 2022, the National Institute for Health and Care Excellence (NICE) undertook a detailed appraisal of whether it should broaden the perspective it uses in its economic evaluations, including consideration of wider societal impacts. Following this review, and after examining both international comparisons, and the significant methodological and ethical challenges involved, NICE’s Board concluded that it should retain its current approach of using a health-sector perspective routinely, but with the flexibility to include wider societal benefits when they are especially relevant.

Whilst the expertise of the JCVI rightly centres on disease burden, vaccine efficacy, health outcomes and health-related costs, as outlined this is not a key reason for why the cost-effectiveness methodology for vaccines does not formally take into consideration wider socio-economic benefits.