The team used two separate approaches in the study . The first looked at the “cost-of-illness” and focused on things like the cost of treatment and productivity losses. This approach found a 16 US dollar return on every one dollar spent. The second was the “full-income approach” which looked at the broader economic and social benefits of living a longer and healthier life. This approach found a 44-dollar return on every one dollar spent. Supply chain, service delivery and vaccine costs were all included to determine the prices of vaccinations.The study assessed 10 vaccine-preventable infections: Haemophilus influenzae type b, hepatitis B, human papillomavirus, Japanese encephalitis, measles, Neisseria meningitis serogroup A, rotavirus, rubella, Streptococcus pneumoniae and yellow fever.We spoke with lead author Sachiko Ozawa , from the Johns Hopkins Bloomberg School of Public Health.Comprehensive evidence on the value of vaccination is limited. A return on investment analysis for immunization in low-and middle-income countries can be an important policy-making tool for key stakeholders, including funders and multilateral organizations.We found that immunizations are an excellent investment. When looking only at the costs associated with illness, such as treatment costs and productivity losses, net benefits of immunization were 16 times the projected costs across low- and middle-income countries over the decade. Taking into account the broader economic and social benefits, the return on investment in immunization was 44 times larger than the projected costs. Immunization not only saves lives, but also contributes to the social and economic wellbeing of communities.In addition to saving lives, immunization significantly reduces illnesses and disability caused by vaccine-preventable diseases. Immunization also saves money for individuals and families by averting healthcare costs, productivity losses, and lost wages associated with illness or care-seeking. In the short term, families save time and money that can be better spent to improve their economic wellbeing. In the long term, people will be healthier and more productive in the workplace and in their communities.A return on investment quantifies the net benefits gained from every dollar invested on an aggregate level. The 16-dollar return for every dollar invested in immunization over the decade comes from using the ‘cost-of-illness’ method, which estimates savings in healthcare costs and lost productivity due to care-seeking, death and disability. The ‘full income approach’ goes beyond the cost of illness by quantifying the value people place on living longer and healthier lives. It is important that comparisons be made between return on investment estimates that utilize comparable methods.We found that net benefits exceeded costs across all ten antigens during the decade. Our return on investment results for each antigen are based on countries in which associated vaccines are delivered during 2011-20, and do not suggest that certain vaccines should be prioritized over others.There are many factors influencing vaccination coverage. Cost is a particularly important factor for the countries included in this analysis. This is why in order to make the estimated return on investment for 2011-2020 a reality, governments and donors must meet the projected funding requirements for immunization programs over the next 5 years.This study was conducted under the assumption that projected immunization program costs will be fully financed across 94 low- and middle-income countries for the next five years. Our team is working on a separate analysis estimating the potential funding gap between projected immunization program costs and corresponding funding levels.This study focused exclusively on the return on investment for immunization in low- and middle-income countries. The return on vaccinations in high-income settings is a potential area for future analyses. Return On Investment From Childhood Immunization In Low- And Middle-Income Countries, 2011-2020 " in Health Affairs by Sachiko Ozawa, Samantha Clark, Allison Portnoy, Simrun Grewal, Logan Brenzel and Damian Walker.Image courtesy of UNAMID