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The House of Lords is scheduled to consider the following question for short debate on 8 January 2026:

Baroness Ritchie of Downpatrick (Labour) to ask His Majesty’s Government what plans they have to include wider societal and economic benefits within the vaccine health technology assessment, rather than limiting evaluation solely to clinical outcomes.

1. Vaccine approval in the UK

In the UK, new vaccines must be tested in laboratories on cells and animals before moving on to clinical trials.[1] Three phases of clinical trials are conducted with increasingly large cohorts, starting with fewer than 100 and ending with several thousand people. Before they can be used in the NHS, vaccines must receive market authorisation and undergo a health technology assessment (HTA). These two processes are increasingly being conducted in parallel.[2]

1.1 Market authorisation

To be approved for use in the UK, vaccines must be licensed. The medicines regulator, the Medicines and Healthcare products Regulatory Agency (MHRA), reviews the evidence from the clinical trials to assess a vaccine’s quality, effectiveness and safety.[3] If the benefits are deemed to outweigh the risks, then the MHRA will grant a medicines licence, also known as marketing authorisation, which allows it to be supplied and sold in the UK.

1.2 Health technology assessment

To be recommended for use in the NHS, medicines must first undergo an HTA. The World Health Organisation (WHO) defines an HTA as “a systematic and multidisciplinary evaluation of the properties of health technologies and interventions covering both their direct and indirect consequences”.[4] The process differs for prophylactic vaccines, which are used to prevent infection, and therapeutic vaccines, which are administered after infection to alter the course of the disease.[5] However, the HTA methodologies are similar.

Prophylactic vaccine assessment

Prophylactic vaccines, also known as preventative vaccines, are considered by the Joint Committee on Vaccination and Immunisation (JCVI), an independent expert committee which advises UK health departments.[6] The JCVI provides advice on the introduction, changing or discontinuation of vaccination programmes in the UK.[7] The Health Protection (Vaccination) Regulations 2009 require the secretary of state for health to “ensure, so far as is reasonably practicable, that the recommendation of the JCVI is implemented”. This statutory status applies in England and Wales only.

The JCVI considers clinical outcomes, such as the burden of disease and the safety and efficiency of the vaccine, and cost effectiveness of immunisation strategies.[8] This is intended to be in line with the methodology used by the National Institute for Health and Care Excellence (NICE) to ensure consistency in spending decisions for different technologies.[9]

Therapeutic vaccine assessment

In England and Wales, HTAs for therapeutic vaccines are conducted by NICE, an executive non-departmental public body sponsored by the Department of Health and Social Care (DHSC). The All Wales Medicines Strategy Group is also able to recommend medicines where there is no NICE assessment.[10] Following an HTA, if NICE recommends a medicine it normally must be available in the NHS in England within three months.[11]

HTAs consider clinical outcomes and cost effectiveness. According to the NICE HTA manual, HTAs employ two forms of economic evaluation: cost-utility and cost-comparison.[12] Cost-utility analysis “is used to determine if differences in expected costs between technologies can be justified in terms of changes in expected health effects”. Health effects are measured as quality-adjusted life years (QALYs), a measure of the quantity and quality of life gained by an intervention.[13] Cost-comparison analyses concern “the costs and resource use associated with the technology compared with that of the comparator(s)”.[14]

2. Societal and economic benefits of vaccines

By improving the health of individuals, medicines can also bring broader societal and economic benefits. Researchers from the Office of Health Economics (OHE), an independent research organisation, concluded that preventative vaccines have particularly large socioeconomic benefits compared to other technologies.[15] Some key benefits are explored below.

Vaccines may bring gains in productivity and educational attainment. This is because preventing infections can improve cognitive performance and reduce lost days of work or education due to illness or caring for an unwell person.[16] For example, the OHE estimated that absenteeism caused by respiratory infections, including influenza and Covid-19, costs employers £852 per employee per year.[17] This equates to £44bn across the UK annually. The Royal College of Paediatrics and Child Health adds that reducing vaccine-preventable childhood illness can increase school attendance, educational access and performance.[18]

Vaccines may also improve people’s quality of life by providing peace of mind through reducing the fear of severe illness.[19] This was highlighted in the JCVI’s code of practice as an impact that would not be included in their cost effectiveness assessment.[20]

Vaccines also have an impact on the risk of antimicrobial resistance (AMR). AMR occurs when microbes causing infectious diseases, such as bacteria, viruses or fungi, evolve resistance to antimicrobial drugs, such as antibiotics, antivirals and antifungals, making infections more difficult to treat.[21] Overuse of antimicrobials increases the risk of AMR. Vaccines can help by reducing infections and therefore reducing the use of antimicrobials.[22] While the JCVI acknowledges the importance of vaccines in reducing the risk of antimicrobial resistance (AMR), it does not consistently consider this in its assessments.[23]

3. Including socioeconomic impacts in vaccine health technology assessments

3.1 Current UK policy

NICE and JCVI currently employ a “health sector perspective” meaning HTAs are focused on healthcare impacts. However, they may also consider some socioeconomic factors in exceptional cases.[24]

The NICE HTA manual states that economic evaluations should ordinarily only consider costs to the NHS and care services.[25] HTAs may also account for healthcare cost savings offered by a technology, such as reducing the length of hospital stays. Evaluations may sometimes consider benefits to other government bodies with permission from DHSC, for example, if a technology combatting drug misuse could reduce crime. However, impacts on productivity are explicitly excluded from HTAs.[26]

JCVI’s assessments are intended to be consistent with NICE’s methodology, therefore socioeconomic factors are not included in the cost effectiveness analysis for preventive vaccines.[27] However, these factors may be highlighted by the JCVI to inform policy making.[28]

3.2 Support for the societal perspective

Some academics have called for more consistent inclusion of socioeconomic factors in NICE and JCVI assessments.[29] This is known as a “societal perspective”.[30]

Studies have reported that failure to consider broader socioeconomic benefits results in vaccines being undervalued.[31] For example, a study considering two UK vaccine strategies, for Clostridioides difficile and infant respiratory syncytial virus infections, estimated that cost savings may be 10% and 76% higher respectively when productivity costs are accounted for.[32] It is argued that undervaluation may lead to underinvestment and underutilisation of vaccines which could ultimately result in detrimental effects for population health and economic growth.[33]

3.3 Challenges and criticism of the societal perspective

Incorporating the broader impacts of vaccines in HTAs would require addressing some key methodological challenges.[34] This includes a lack of quality data on the socioeconomic impacts of vaccines. This is due in part to the fact that these factors are not considered by HTA bodies and so the collection of this data is not routine.[35]

There is also no consensus on how socioeconomic impacts should be estimated. This can be particularly challenging for certain complex issues, such as modelling the impact of vaccines on AMR risk or quantifying the value of unpaid work, such as caring.[36] Assigning values to certain social benefits can also be contentious and may require consultation with the public and stakeholders.[37] Combined with poor data, these methodological challenges mean that inferences on socioeconomic impacts of vaccines currently come with high levels of uncertainty.[38]

The OHE highlights additional structural and ethical challenges.[39] Firstly, it argues that the siloed nature of public sector budgets incentivises a focus on clinical outcomes and healthcare costs. NICE argues that if HTAs are to consider impacts on other sectors, other sectors must also routinely evaluate impacts of policies on health to avoid underfunding healthcare.[40] Secondly, there is a concern that incorporation of productivity impacts would incentivise targeted healthcare funding towards groups with higher earning potential, exacerbating health and socioeconomic inequalities.

Following a 2022 appraisal, NICE opted to maintain its approach of only considering broader socioeconomic factors in exceptional circumstances.[41] NICE stated that adopting a societal perspective would require more research into non-health impacts, greater coordination across public sectors and additional time, resources and expertise to review socioeconomic evidence.[42] NICE concluded that this work “would be disproportionate to any expected benefits to the quality of NICE decisions given the existing flexibilities to include relevant wider effects”.

As well as echoing the methodological and ethical challenges discussed above, NICE stated that incorporating wider effects could risk making health technologies more expensive as it may allow manufacturers to justify increasing prices for the NHS.[43] They reported that this motivated the Portuguese HTA agency, INFARMED, to stop considering productivity impacts in their HTAs.

3.4 International comparisons of vaccine assessment perspectives

Countries vary with regards to which, if any, socioeconomic impacts are included in vaccine HTAs and whether they are included as standard or if they can only be included as supplementary analysis.[44] For example, a 2022 study reported that of 46 countries studied, 32 (67%) had guidelines recommending that productivity costs should not be included as standard.[45] Countries that recommended the inclusion of productivity loss included Denmark, Spain and Sweden. Sweden, in particular, incorporates a range of broader impacts in its vaccine HTAs, including productivity losses from patients and carers.[46]

4. Read more

Image by Nappy on Unsplash.

References

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  2. Medicines and Healthcare products Regulatory Agency and National Institute for Health and Care Excellence, ‘Patients will receive medicines 3–6 months faster under 10-year health plan, as regulators set out plans’, 6 August 2025. Return to text
  3. Medicines and Healthcare products Regulatory Agency, ‘More information about the MHRA’, 16 January 2023. Return to text
  4. World Health Organisation, ‘Health technology assessment’, accessed 11 December 2025. Return to text
  5. Robert Rich, ‘Clinical immunology: Principles and practice’, 2023, p 539. Return to text
  6. House of Commons, ‘Written question: Urinary tract infections: Vaccination (57594)’, 10 June 2025. Return to text
  7. Joint Committee on Vaccination and Immunisation, ‘Code of practice June 2013’, June 2013. Return to text
  8. House of Lords, ‘Written question: Vaccination (HL11819)’, 20 November 2025. Return to text
  9. Joint Committee on Vaccination and Immunisation, ‘Code of practice June 2013’, June 2013, pp 7, 34 and 37. Return to text
  10. All Wales Therapeutics and Toxicology Centre, ‘Our committees’, accessed 22 December 2025. Return to text
  11. The National Institute for Health and Care Excellence (Constitution and Functions) and the Health and Social Care Information Centre (Functions) Regulations 2013, SI 2013/259. Return to text
  12. National Institute for Health and Care Excellence, ‘NICE technology appraisal and highly specialised technologies guidance: The manual’, updated 17 December 2025, pp 66–9. Return to text
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  18. Royal College of Paediatrics and Child Health, ‘Vaccination in the UK: Access, uptake and equity’, July 2025, p 6. Return to text
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  24. National Institute for Health and Care Excellence, ‘Options appraisal for adopting a wider perspective in NICE assessments’, 16 December 2022, p 8; and House of Lords, ‘Written question: Vaccination (HL11819)’, 20 November 2025. Return to text
  25. National Institute for Health and Care Excellence, ‘NICE technology appraisal and highly specialised technologies guidance: The manual’, updated 17 December 2025, p 39. Return to text
  26. As above, p 66. Return to text
  27. Joint Committee on Vaccination and Immunisation, ‘Code of practice June 2013’, June 2013, pp 7, 34 and 37. Return to text
  28. House of Lords, ‘Written question: Vaccination (HL11819)’, 20 November 2025. Return to text
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  32. Margherita Neri et al, ‘Impact of including productivity costs in economic analyses of vaccines for C. difficile infections and infant respiratory syncytial virus, in a UK setting’, Cost Effectiveness and Resource Allocation, 2024, vol 22. Return to text
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  37. National Institute for Health and Care Excellence, ‘Options appraisal for adopting a wider perspective in NICE assessments’, 16 December 2022, pp 13–14. Return to text
  38. As above, p 11. Return to text
  39. Office of Health Economics, ‘Assessing the productivity value of vaccines in health technology assessment: Worth a shot?’, 17 September 2020. Return to text
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  43. As above, p 10. Return to text
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