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A SI DE FRO M TH E multiple benefits to public health, successful nationwide vaccination programs have signifi cant economic implications. If every child born in the United States in a given year were immunized: + 42,000 early deaths would be prevented + 20 million cases of disease would be avoided + $13.5 billion in direct costs would be saved + $68.8 billion in total societal costs would be saved + $10 in societal costs would be saved for every $1 spent on vaccines Source: Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009; Pediatrics, March 2014 Threading the needles By Colin Stayton DATA FROM THE PAST TWO DECADES KNIT A PERSUASIVE NARRATIVE ABOUT THE BENEFITS OF VACCINATION. L O N G -TE R M CLI N IC AL R E S E ARCH efforts have yielded solid evidence favoring widespread use of vaccinations to combat illnesses that, prior to vaccine development, were capable of devastating large swaths of the popula- tion. But a competing narrative outlining the perceived harms of vaccination has been diffi cult to root out of the collective consciousness, leading to dramatic drop-offs in immunization rates at various times and in various places. Researchers draw a correlation between these tapering-off periods and subsequent outbreaks of vaccine-preventable illnesses. THE COST-EFFECTIVENESS OF vaccination programs can be gauged in many ways. The World Health Organization (WHO) uses disability-adjusted life years, or DALYs, to measure the lost value caused by death or illness. The cost of averting one DALY with vaccines ranges from $7 to $438. WHO deems any intervention that averts a DALY and costs less than the average gross domestic product (GDP) per capita "very cost-effective." Estimated world GDP per capita in 2013 was $13,100. In the United States, the fi gure was $52,800. Sources: Disease Control Priorities in Developing Countries. New York: Oxford University Press; 2006. Retrieved from gavialliance.org; the CIA's World Factbook A 2013 EMORY UNIVERSIT Y study found the risk of whooping cough was 20 percent greater in clusters of people who had obtained nonmedical exemptions from vaccinations than in clusters of people who had not. Source: HealthDay IN THE UNITED STATES , falling rates of diphtheria, tetanus and pertussis (DTaP) vaccination appear linked to a rise in whooping cough cases: Sources: Council on Foreign Relations, Vaccine-Preventable Outbreaks map, January 2014; the CDC + 7,580 — whooping cough cases in 2001 + 85% — children 19–35 months of age who received DTaP vaccine in 2007 + 48,277 — whooping cough cases in 2012 + 95% — children 19–35 months of age who received DTaP vaccine in 1996 at risk 2 0 1 4 S E P T E M B E R /O C T O B E R ■ M D N E W S . CO M ■ MD NEWS Cleveland/Akron/Canton | 2 5