Investing In Health Pays A Double Dividend

By Dr. Edith MaesResearch Fellow at Maastricht School of Management, The Netherlands

The success of a nation is largely dependent on human welfare, of which health is a direct source. High levels of population health go hand-in-hand with high levels of national income. 

To the extent that income is a consequence of health, investment in health, even in low and middle income countries, should be a priority[1]. For example, the relative low cost of some widely introduced public health interventions such as greater access to clean water and sanitation have had large-scale effects on population health and increased survival.

In turn, higher incomes promote better health through improved nutrition, education, and increased ability to purchase more and better health care1. Thus, investments in healthcare and in preventative healthcare services in particular are a promising instrument for growth in countries with fast developing economies but still high burdens of disease.

The economic effects of population health can be seen both at the individual and macroeconomic levels1. Health as a form of a nation’s human capital stems from the premise that ill health costs labour time, lowers worker productivity, and domestic output.

Thus, one of the levers to a more productive nation would be preventative health care, as preventing the spread of diseases through means such as vaccination yields high rates of return.

Treating diseases is often more costly and prevention is usually deemed better than a cure. Additionally, where public funding or private insurance is limited, ill health can impose large out-of-pocket expenses, reducing overall household savings.

Barring the monetary costs of illnesses, poor nutrition and healthcare in early childhood can have tremendous consequences in later life as it has a large effect on both physical and cognitive development. Simply put, healthier children make smarter students and eventually more productive adults.

Additionally, the odds of being susceptible to chronic disease in later life are directly linked to early childhood nutrition and health – healthier infants lead to healthier adults, suggesting that investments in health in early life pay off in terms of less healthcare costs, greater household savings, and potentially higher levels of prosperity throughout life.

This is where vaccination steps in. Children worldwide are routinely vaccinated against major childhood diseases, including increasingly against the two deadliest diseases such as pneumococcal disease and diarrhoea.

Today, more than 30 diseases are vaccine-preventable. Worldwide regarded as one of the most important and cost effective public health measures[2], vaccines prevent the pain, suffering, disability and death from diseases.

With vaccination, one could potentially lower the cost of medical care, minimise days of work lost due to illness or the need to care for an ill family member. Families do not have to make up for lost income and the economy benefits from a healthy, more productive workforce.

Unfortunately, vaccination coverage rates remain far from universal in many countries3. In countries such as Malaysia where routine childhood vaccination programmes are in place, the introduction and funding of the newer vaccines may pose new challenges.

While there is a strong moral imperative to increase access to life-saving vaccines, there is also an important cost-effectiveness argument. In addition to preventing future morbidity and mortality, vaccines have features that require special consideration when assessing their cost effectiveness[3].

Appreciation of the full value of vaccines requires a broader health economic perspective when assessing vaccination programmes for public funding as it is not or not fully captured by traditional health technology-related assessment tools designed for medicines. For example, when a high percentage of vaccination is achieved, communities benefit as the spread of disease declines. Society as a whole benefits from this ‘herd immunity’.

Thus, one generation benefits subsequent generations when disease rates fall in both vaccinated children and unvaccinated adults. Also, many vaccines prevent short-lived illnesses in very young children that cause extra family care and work loss, leading to indirect quality-of-life effects which may not be taken into account in evaluation methods.

It is argued that guidelines for health economic evaluations include a wider perspective to account for the full benefits and costs when demonstrating the value of vaccines to government decision-makers4.


Zura Baharuddin is an outspoken advocate of vaccination. She should know – her son, Mohd Amir Reza – fell violently ill before his first birthday due to an infectious disease.

“I will never forget what happened last June – it’s something no parent should go through,” said Baharuddin. “Reza was only 11 months old when he was admitted to the hospital for Pneumococcal Meningitis.”

“It started as a normal fever, so we thought it was because he was teething. By the third day, he became worse – he was vomiting constantly. We thought that it was because he was breast-fed, and I had eaten something spicy. We were wrong.”

“By the time he reached the hospital, his body was limp and he had a blank stare.  He was admitted into the Intensive Care Unit for five days and for two weeks, we endured looking at our son fighting the infection.  The future seemed so uncertain; we weren’t sure what lay ahead of us.  We only prayed and hoped that he’d survive.”

“Fortunately, by the fourth day of treatment, Reza showed signs of recovery.  He was able to sit up, smile and clap his hands.  We were so glad that our prayers were answered and we have Reza back in our arms, safe and sound.”

“Looking back, I should have given him the Pneumococcal vaccination – my paediatrician did mention it to me.  But I thought it’s wasn’t necessary since it’s not a mandatory vaccine and it was quite costly. But after the bitter experience of seeing my son suffer, I will not allow costs to ever be a deterrent for the well-being of my children again, especially when I compared it to the huge hospital costs of RM16,000, plus the emotional distress we had to go through.”

“Nowadays, when I meet other parents, I share my story with them, in the hope that they never had to go through what I went through.  I strongly urge all parents to please protect their children.  No cost is ever too great for the benefit of our children’s health.”


Unfortunately, Reza’s story is all too common. Approximately 14.5 million episodes of serious pneumococcal disease are reported globally every year in children under the age of five,and more than half of these cases occur in Asia and Oceania[4].  About one third of deaths occur in Asia and Oceania, where approximately one child dies every two minutes from the disease.3

Despite streptococcus pneumoniae being a leading cause of invasive bacterial pneumonia, meningitis, and sepsis in children worldwide, many countries lack national estimates of disease burden.This is a cause for concern as effective interventions are available, including a pneumococcal conjugate vaccine.3

Including the pneumococcal conjugate vaccine in the national immunization programme in Malaysia would save the lives of 336 babies over a period of 10 years.  With the addition of herd effects, a further 72 deaths can averted in adults[5].  The inclusion of the pneumococcal conjugate vaccine would further benefit the country through these averted deaths, hospitalised cases and lead to cost saving – all positive factors, versus the action of “doing nothing”5.


The lack of disease awareness around pneumococcal disease with parents and caregivers[6] combined with difficulties in accurately diagnosing pneumococcal infections[7] and limitations to current effective treatments for pneumococcal disease8 make it difficult to manage from a public health perspective.

The World Health Organization considers pneumococcal disease to be the number one vaccine preventable disease[8] with immunization being arguably the most efficient and cost-effective way of reducing illness and mortality from infectious diseases such as pneumococcal disease.[9] [10]

Vaccination can prevent pneumococcal disease[11] and today, safe, well-tolerated and highly cost-effective pneumococcal conjugate vaccines (PCV) exist that can save many babies and young children from pneumococcal-related death and disability[12].

This community message is brought to you by Pfizer.

[1] Bloom DE, Canning D. Population Health and Economic Growth. Working Paper N°24; Commission on Growth and Development, 2008.

[2] Bloom DE, Canning D, and Weston M. The Value of Vaccination. World Economics, Vol. 6, n°3, 2005:p.15-39

[3] Beutels P. Scuffan PA., MacIntyre CR. Funding of drugs: do vaccines warrant a different approach? Vol. 8, November 2008: p727-733.

[4] O’Brien KL et al. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet 2009; 374: 893-902.

[5] Syed Aljunid et al. Impact of routine PCV7 (Prevenar) vaccination of infants on the clinical and economic burden of pneumocaccal disease in Malaysia. BMC Infectious Diseases 2011, 11:248

[6] UNICEF/WHO.  Pneumonia: the forgotten killer of children, 2006. MICS and Demographic Health Surveys (DHS) data from 33 Multiple Indicator Cluster Surveys (MICS) conducted between 1999-2001

[7] O’Brien KL et al. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet 2009; 374: 893-902.

[8] World Health Organization. Weekly Epidemiological Record,  24 OCTOBER 2008, No. 43, 2008, 83, 385–392.

[9] Andre FE et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bulletin of the World Health Organization 2008; 86: 81 1–160.

[10] Centers for Disease Control and Prevention. Vaccine Preventable deaths and the global immunization vision and strategy, 2006-2015. MMWR 2006;55:511-5

[11] All-Party Parliamentary Group on Pneumococcal Disease Prevention in the Developing World. Improving global health by preventing pneumococcal disease. (2008)

[12] Kyaw MH et al. for the Active Bacterial Core Surveillance of the Emerging Infections Program Network. Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. New Eng J Med 2006; 354: 1455–63.

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