The Value-Based Vaccination Approach: Strengthening Sustainable Healthcare Systems

Healthcare systems worldwide are under pressure to optimize resources while still delivering high-quality, patient-centred care. Achieving long-term sustainability requires a shift toward frameworks that support financial efficiency and improved health outcomes. Value-based vaccination, a core application of value-based healthcare, provides a comprehensive framework for evaluating the broader impact of vaccines across personal, societal, allocative, and technical dimensions.

First introduced in 2010, value-based healthcare initially centered on efficiency and on health gains relative to resources invested.

Today, the concept is broader and built on four interconnected pillars essential for solidarity-based healthcare systems:

• Personal value: Ensuring vaccination aligns with individual goals and patient needs.

• Societal value: The contribution of vaccination to community wellbeing, social participation, and collective protection.

• Allocative value: Equitable distribution of vaccination resources across populations.

• Technical value: The efficiency and effectiveness of vaccination strategies.

When applied to vaccination, these four pillars highlight benefits that go far beyond disease prevention. Vaccination generates productivity gains, reduces care needs, offers community protection (including herd immunity), and strengthens social cohesion. These broad benefits contribute directly to the Sustainable Development Goals by fostering healthier, more economically stable societies.

Increased investment in vaccination programs, coupled with greater recognition of the full value of vaccines, will save lives, reduce long-term costs, and improve health outcomes across the life course. Vaccination should therefore be viewed not only as disease prevention, but as a high-value public health investment.

This report synthesizes evidence on the personal, societal, allocative, and technical pillars of value-based vaccination. It provides recommendations for advancing meaningful policy actions that reflect the full value of vaccines.

Issue

Healthcare systems must optimize resources while maintaining patient-centered care. Sustainability efforts must evaluate financial realities and quality improvements. Value-based vaccination supports this balance by ensuring decisions reflect outcomes that matter to individuals, communities, and health systems as a whole.

Approach

A systematic review of English-language literature published between December 24, 2010, and May 27, 2020, was conducted across three central scientific archives. Studies were included if they addressed the value of vaccination against vaccine-preventable diseases and were conducted in advanced economies, as defined by the International Monetary Fund.

A detailed analysis was conducted of studies in which value was a key focus. A steering committee of international vaccination experts contributed additional insights and helped develop recommendations.

Results

The review identified 107 studies, with the following trends:

• 72.9% were primary research studies.

• Approximately half directly addressed the value.

• 83.3% evaluated only one value pillar.

• Two-thirds focused on technical value.

• Only 11.1% addressed allocative value, and 16.7% addressed societal value.

Key findings include:

• Technical value is typically evaluated through cost analyses (cost-effectiveness, cost-utility, cost-benefit, cost-of-illness, and budget impact). Still, these traditional economic models often fail to capture the broader societal benefits of vaccination.

• Personal value is most often assessed through attitudes, preferences, and perceptions—essential factors for improving vaccine uptake.

• Societal value encompasses indirect protection (herd immunity), reduced antimicrobial resistance, social responsibility, cohesion, and overall population well-being, all of which require further evidence.

• Allocative value is often limited to affordability but should also encompass equity, accessibility, and appropriate resource allocation.

Recommendations

The steering committee and evidence synthesis generated the following recommendations to support value-based decision-making for vaccines.

Decision-Making Process

• Develop capacity-building initiatives for researchers and policymakers to strengthen the integration of value-based vaccination in decision-making.

• Embed all four pillars of value into national, regional, and supranational vaccine policy frameworks.

• Improve governance by increasing collaboration between authorities, health professionals, scientists, citizens, and industry.

• Promote shared decision-making across all stakeholders involved in vaccination programmes.

Research

• Build consensus on the dimensions of the four value pillars as they apply specifically to vaccination.

• Identify barriers to assessing the full value of vaccines.

• Expand and translate research on the broad societal impact of vaccination.

• Strengthen evidence generation to support evidence-based vaccine policy and post-implementation evaluation.

• Develop tools and models that enable HTA and related frameworks to more accurately assess the full value of vaccination.

• Foster innovative public–private partnerships that support sustainable vaccine development.

Public Engagement

• Identify key levers that can increase public understanding of the full value of vaccination.

• Improve vaccination literacy among healthcare professionals and the general population.

• Develop and test strategies that actively engage communities in vaccination efforts.

Moving Forward to Strengthen Value-Based Vaccination

Integrating the full spectrum of value (personal, societal, allocative, and technical) is essential for strengthening sustainable healthcare systems and unlocking the broad benefits of vaccination. By enhancing evidence generation, improving decision-making frameworks, and elevating public engagement, value-based vaccination can support healthier, more resilient societies for generations to come.