Beyond the Price Tag: Dr. Nelly Bosire on Vaccine Economics, Equity, and Public Trust

An expert perspective on why vaccine cost-effectiveness must account for local healthcare realities, patient safety, and sustainable immunization programs.

by Dr. Nelly Bosire - Obstetrician & Gynaecologist | Nairobi County, Kenya

Expert commentary on the recent article published October 7, 2026 on MedikaLife: Rethinking vaccine costs: how the “more expensive” vaccine can actually save health systems millions

Maternal and childhood immunization: What lessons can be drawn from this analysis regarding vaccine safety, caregiver confidence, and the importance of minimizing adverse events that may discourage vaccination?

It is important to appreciate that adverse events are part and parcel of vaccine effects. A vaccine is only licensed for use where the benefits far outweigh the impact of adverse events. That said, adverse events are well-recognized, with care protocols in place. Calculating the cost of managing vaccine adverse effects will vary greatly by country. In a middle-income country like Argentina, an event warranting a visit to the primary care provider or hospitalization will vary greatly from a low-income country where the threshold for hospitalization is perhaps a lot higher. Again, the concept of willingness to pay comes into play. Whereas in Argentina, the child may have to be seen by a physician, driving up the cost of care; a similar event in a low-income country may be attended to by an immunization nurse, at a much lower cost; creating vastly different results when cost-saving analysis is done. A standard measure cannot exist when country health system resources vary so broadly. 

Health policy and implementation: How can governments and public health authorities better incorporate health economic evidence into national immunization strategies while balancing affordability, accessibility, and long-term sustainability?

Applying the VPOP guidelines goes a long way in ensuring this happens. Stringent analysis of in-country disease burden, measured against programmatic cost, cost of vaccine, and willingness to pay, forms the basis for these economic evaluations, providing country-specific cost-effectiveness of vaccine adoption. 

Global applicability: What challenges should African healthcare systems consider when evaluating economic findings from Argentina, particularly given differences in healthcare infrastructure, financing, vaccination coverage, and disease burden?

As mentioned above, economic evaluations will differ from country to country based on a country's GDP. In applying the model there are assumptions made for Argentina that may vary widely in low- and lower-middle-income countries; most notable being the cost of the management of adverse events. The cost of healthcare varies, as does the threshold for seeking care in the first place. For instance, not all hospitalizable cases will actually be hospitalized. And even in the face of hospitalization, cost of care will be lower when the threshold for critical care is higher in resource-constrained countries, remarkably altering the end results in the modeling. 

We would particularly appreciate your thoughts on how economic evaluations can support evidence-based vaccine procurement decisions without compromising equitable access or public trust in immunization programs.

Economic evaluations are key in demonstrating vaccine impact and providing an objective, evidence-informed analysis of the feasibility of vaccine adoption. The biggest challenge many countries face is concise data that goes into the applied formulae. For instance, many countries with poor disease surveillance capabilities are unable to evaluate their disease burden; hence, they tend to use data from other similar countries instead. 

Public trust is best built through adequate and sustained evidence-based communication regarding vaccines. Timely management of disinformation is critical, especially in the era of social media. Vaccine equity is achieved through making decisions based on scientific evidence and well-thought-out sustainability strategies. Strategies to manage vaccine hesitancy, vaccine access, and vaccine acceptability must be in place even before adoption of a new vaccine.

For existing programmes, timely adjustments based on evidence, supported by well-managed programmatic switches, are critical. For instance, the evidence supporting a single dose of HPV vaccine is very strong. Switching from two doses to one reduces cost and supports sustainability. However, lack of adequate public education had many thinking that the single dose was a different vaccine altogether, wondering whether they needed to take their fully vaccinated girls back to the health facility to get it.