Vaccination would save more money than it costs to deliver
As COVID-19 recedes from the forefront of public consciousness, a University of Michigan study published in JAMA Network Open offers a quiet but consequential reminder: the economic logic of vaccination has not expired. Analyzing the 2023-2024 updated mRNA vaccine across age groups, researchers found that vaccinating older Americans saves more than it costs — in hospitalizations avoided, lives preserved, and productivity sustained. The findings arrive at a moment of striking paradox, when the tools of prevention remain sound while the will to use them has quietly eroded.
- Vaccination uptake has fallen sharply — only 23-28% of eligible adults received the latest updated COVID vaccine, even as tens of thousands of Americans still died from the disease in 2024.
- For adults over 65, the numbers are unambiguous: every 100,000 people vaccinated would prevent 391 hospitalizations and 43 deaths, generating net economic savings that outweigh the cost of the program.
- The economic case extends to middle-aged adults 50-64 and holds within acceptable thresholds even for healthy adults 18-49, though the benefits diminish with age and health risk.
- A second dose makes economic sense for older and immunocompromised adults but not for younger healthy populations — a distinction the CDC's current guidance already reflects.
- Researchers caution that declining hospitalization rates may gradually erode the economic justification for broad vaccination, making the present window of clear cost-effectiveness one that may not remain open indefinitely.
A University of Michigan research team has completed a rigorous economic analysis of COVID-19 vaccination, and the conclusion is direct: for older Americans, vaccinating costs less than not vaccinating. The study, published in JAMA Network Open under a CDC contract, modeled outcomes from a single updated mRNA dose during the 2023-2024 season across three adult age groups.
For adults over 65, the case is strongest. Every 100,000 people vaccinated would see 391 hospitalizations and 43 deaths prevented — and when the full accounting is done, the savings in medical costs and preserved productivity exceed the cost of vaccination itself. Researchers noted this finding held firm across a wide range of assumptions. For adults 50-64, vaccination also represents a sound economic investment. Even for healthy adults 18-49, the cost-effectiveness falls within thresholds public health economists consider acceptable, though the benefits are proportionally smaller.
One policy-relevant finding: a second dose is economically justified for adults over 65 but not for younger, non-immunocompromised adults — a distinction already embedded in current CDC guidance. Lead researcher Lisa Prosser also noted the model likely understates true savings, since it excludes costs like wages lost by family caregivers or patients' out-of-pocket expenses.
The backdrop matters. More than 47,000 Americans had COVID-19 listed on their death certificates in 2024, yet vaccination uptake has fallen dramatically — just 28% of Medicare-eligible seniors and 23% of all adults received the most recent updated vaccine. This stands in stark contrast to the early rollout, when most American adults were vaccinated.
Prosser acknowledged that declining hospitalization rates could weaken the economic argument over time. But for now, with costs low and preventable harm ongoing, the evidence points toward broad vaccination as economically rational — a conclusion the data supports even before accounting for the full human cost of lives lost.
A team of researchers at the University of Michigan has completed a detailed economic analysis of COVID-19 vaccination, and the numbers tell a straightforward story: vaccinating older Americans against the virus costs less than it saves. The study, published in JAMA Network Open and funded through a contract with the Centers for Disease Control and Prevention, modeled what happens when you vaccinate different age groups with a single dose of the updated mRNA vaccine available in the 2023-2024 season.
For adults over 65, the math is clearest. A single vaccination would prevent 391 hospitalizations and 43 deaths for every 100,000 people vaccinated. When you add up the cost of those prevented hospitalizations, the medical care that wouldn't be needed, the workdays that wouldn't be lost, and the lives that would be saved, the nation would ultimately spend less money vaccinating everyone in that age group than it would save. The researchers, led by Lisa Prosser and David Hutton at the University of Michigan, found this result held true across a wide range of different assumptions about how the virus might behave or how much medical care might cost.
For middle-aged adults between 50 and 64, vaccination also pencils out as a sound economic investment. Even vaccinating healthy young adults from 18 to 49 would fall within what public health economists consider acceptable cost-effectiveness thresholds, though the benefits are smaller in that younger group. For every 100,000 young adults vaccinated, the model predicted 39 hospitalizations and just 1 death prevented. The number of COVID cases of any severity that could be prevented was similar across all three age groups—between 7,600 and 8,900 per 100,000 vaccinated.
One finding stood out as important for policy: a second dose made economic sense for adults over 65, but not for younger, non-immunocompromised adults. The CDC has recommended second doses for older adults and immunocompromised people for the past two vaccination seasons, and this analysis supports that approach. Prosser noted that the model likely understates the true savings because it doesn't account for some real costs that vaccination prevents—like the wages lost by family members who stay home to care for sick relatives, or the out-of-pocket expenses patients pay for treatment and transportation to medical care.
The context for this analysis is important. More than 47,000 Americans had COVID-19 listed on their death certificates in 2024, a sharp decline from the early pandemic years but still a substantial number. Yet vaccination uptake for the most recent vaccines has dropped significantly. As of February 2025, only 28 percent of Medicare-eligible adults over 65 had received the 2024-2025 vaccine. Among all adults, just 23 percent reported receiving the updated vaccine as of April 2025. This represents a dramatic shift from the early days of the vaccine rollout, when the vast majority of American adults received at least one dose.
The University of Michigan team has been studying vaccine cost-effectiveness for years under CDC contract, and their earlier work showed that the entire national investment in developing, purchasing, and distributing COVID vaccines in 2020 and 2021 paid for itself within a single year—even before accounting for the value of lives saved or productivity preserved. That analysis found that for adults over 40, the nation saved more in avoided medical costs alone than it spent on the entire vaccine effort.
Prosser acknowledged one limitation that could reshape future analyses: COVID hospitalization rates have been declining, which means the economic case for vaccination may become less compelling over time as the disease becomes less severe. Still, with deaths and hospitalizations continuing to occur, and with vaccination costs relatively low, the current evidence suggests that broad vaccination remains economically rational. The CDC currently recommends at least one dose of the current COVID vaccine for everyone over six months old, with a second dose recommended for people 65 and older or those with immunocompromising conditions.
Citas Notables
A single dose of 2023-2024 mRNA COVID-19 vaccine averted substantial illness and death across age groups, and this led to economically attractive results for both of the older age groups.— Lisa Prosser, lead author, University of Michigan
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Why does a study about money matter when we're talking about public health?
Because money is how we decide what's worth doing. If vaccination costs more than it saves, we have to justify it on other grounds. But this study shows we don't have to choose—the economics and the health outcomes point the same direction.
The numbers for older adults look strong. What about younger people?
Younger people get fewer hospitalizations and deaths prevented, so the economic case is weaker. But it's still within what experts consider acceptable. The real question is whether you think preventing even one death per 100,000 young people is worth the cost.
I notice the uptake numbers are really low—23 percent for all adults. Why would people skip a vaccine that saves money?
People don't see the economic calculation the way researchers do. They see a disease that feels less urgent than it did in 2020, and they weigh that against the hassle of getting vaccinated. The study doesn't explain behavior; it just shows what would happen if people did get vaccinated.
What about that second dose recommendation? That seems to be where the analysis gets specific.
Right. The study found that a second dose makes sense for older adults—the benefits outweigh the costs. But for younger, healthy people, a second dose doesn't pencil out economically. So the CDC's current guidance, which recommends second doses mainly for older and immunocompromised people, aligns with what the economics actually support.
The researchers mention their model doesn't count some real costs. What are they leaving out?
Things like the wages lost by someone who takes time off work to care for a sick family member, or what patients actually pay out of pocket for treatment. If you added those in, the savings would probably be even larger. So this is actually a conservative estimate of how much vaccination saves.