Fiscal returns of immunisation programmes in Europe: supporting fiscal sustainability

Background

Under the New Economic Governance Framework (NEGF), European governments need evidence-based approaches to ensure fiscal sustainability whilst investing in growth-enhancing policies. Fiscal Health Modelling (FHM) quantifies how preventive health investments generate fiscal returns through tax revenue gains, productivity preservation, and reduced government transfers. This study synthesises European evidence on the fiscal returns of immunisation programmes to support evidence-based fiscal planning.

Methods

Fiscal benefit-cost ratios (fBCR), net fiscal benefits, and tax revenue gains were extracted from nine European countries reporting fiscal outcomes from immunisation programmes in a targeted literature review of 38 studies across 26 countries.

Results

Influenza vaccination for healthcare workers in Italy increased fiscal revenues by €327K–€388K. In the Netherlands, the COVID-19 (C19) pandemic resulted in €164M total direct fiscal loss (excluding pensions) and €59M in premature mortality-associated tax losses. In the UK, C19 vaccination achieved fBCR of 1.32 for the 18-64 at-risk population, 1.46 for healthcare workers, and 1.54 for informal caregivers (before retirement). Across 12 EU countries, C19 vaccination increased consumption tax gains by 2.2%–10.8%. HPV vaccination achieved fBCR of 1.7 in Germany, 3.8 in Portugal, and 1.2 in Switzerland. Rotavirus vaccination increased tax revenue by US$84M in Turkey and €14.5M in the Netherlands. Paediatric immunisation in Belgium achieved fBCR of 2.2, whilst Greece reported €0.3M in fiscal gains per 1,000 children.

Conclusions

Evidence demonstrates that immunisation programmes in European countries generate positive fiscal returns supporting fiscal sustainability despite methodological heterogeneity. FHM provides quantitative evidence for governments to position immunisation programmes as growth-enhancing health investments aligned with the NEGF.

Key messages

• Immunisation programmes across nine European countries generate positive fiscal returns, with benefit-cost ratios ranging from 1.2 to 3.8, supporting fiscal sustainability across diverse settings.

• Immunisation programmes increase tax revenue, preserve productivity, and reduce government transfers, positioning themselves as investments aligned with the New Economic Governance Framework.