With a growing measles outbreak now stretching from coast to coast, the dangers of the so-called ‘anti-vaccination movement’ have quickly become the focus of a fierce nationwide debate. Health officials, doctors, scientists, and even the President have joined in, urging parents to immunize their children and reminding us of the dire consequences of not doing so.
So far, the ongoing vaccine debate has centered on the health risks of refusing vaccination, both for the unimmunized child and for the community at large. We’ve been reminded, for instance, about how serious measles can be, about the impact of irresponsible doctors’ advice, and about the ramifications of not vaccinating on those unable to be vaccinated.
But few people have brought up the costs. Measles is expensive — really expensive. And even if you live in a highly vaccinated area with no outbreaks, a measles case in your state – that’s a third of the U.S. right now – still means health department tax dollars diverted from other programs to deal with a disease that was eliminated from the U.S. in 2000.
According to the Centers for Disease Control and Prevention, more than 121 cases of measles in 17 states have been confirmed so far this year, 85 percent of which resulted from the outbreak stemming from Disneyland. That’s more cases than were seen in all of 2012 – and it’s only February. While we don’t yet know how much this outbreak will end up costing U.S. taxpayers, figures from past outbreaks give us a pretty good idea.
Experts have calculated that each case of measles costs the public health system upwards of $10,000 to $20,000, although it can be much higher. In 2004, an Iowa college student traveled to India and came back with measles, sparking a two-month containment effort that involved 2,525 hours of personnel time to review flight manifests, contact exposed passengers, set up vaccination clinics, trace more than 1,000 potentially exposed contacts, and institute and enforce quarantine orders for those who had refused vaccinations. Staffers, on high alert putting in extra time, fielded 2,025 phone calls from concerned Iowa residents and drove 2,243 miles. In the end, that single case of measles cost taxpayers a total of $142,452.
In 2011, efforts to contain 107 cases spread across 16 outbreaks cost local and state health departments an estimated $2.7 million to $5.3 million. And that was less than half of the total cost of measles that year, when 220 cases were confirmed. Because measles is so contagious — infecting 90 percent of susceptible people and remaining airborne up to two hours after an infectious person has left the area — the number of contacts a single case can generate grows exponentially once an outbreak begins. The 107 cases in 2011 involved contacting somewhere between 8,900 and 17,450 individuals, which required 42,000 to 83,000 personnel hours.
That doesn’t even include the family costs of an actual measles case, which lasts about seven to ten days, though those costs are a bit harder to measure. And even parents of children who simply attend school with a sick child could end up paying the price for those who refuse to vaccinate. In 2008, an intentionally unvaccinated 7-year-old boy returned to San Diego from Switzerland with the virus and infected 11 other people, costing taxpayers $10,376 per case. That outbreak involved more than 800 exposed individuals, including 48 children too young to be vaccinated who had to be quarantined at a family cost of $775 per child.
In Illinois, ten measles cases have now been confirmed among children at a Chicago-area daycare, eight of whom are infants too young to be vaccinated. That means it’s highly likely that other infants in those classrooms were exposed and will need to be quarantined for up to three weeks, health officials said. Similarly, after one child was diagnosed with measles at a daycare in Santa Monica, the parents of 14 other infants were forced to quarantine their kids. For those families, the costs will very likely be higher than they were in 2008.
The Economic Policy Institute estimates that the median wage for people without sick days is $10 per hour. Assuming the person works five days a week, missing a week of work would cause a loss of $400. If the absence extended to eight days of work and two days of weekend as a result of a ten day illness, the loss would be $640.
But that figure only accounts for an estimate of lost wages, not the any additional costs such as hospitalization. After factoring in the cost of medical care, expenses could be even higher. There are also direct costs to hospitals that ultimately fall on state taxpayers. Often, measles patients will get referred to an emergency room or to a clinic, and then the hospital has to do their own tracing as well and check their health care workers and contact all of the other patients that were there. For example, in 2008, an Arizona measles outbreak that affected 14 patients cost two hospitals nearly $800,000. And in 2011, when an unvaccinated Utah high school student traveled to Europe and came back infected with measles, eight others caught the virus. The Utah Department of Health, Salt Lake Valley Health Department, and Primary Children’s Medical Center calculated the direct cost of staff time, testing, post-exposure vaccines and preventative measures racked up $300,000. Costs for two additional hospitals, a temporary emergency department closure and a school system were not included.
Contrast those numbers with the cost of the MMR (measles-mumps-rubella) vaccine, which prevents the measles in 95 percent of those who get one dose and 99 percent of those who get both doses. A provider under a CDC contract, such as those using the Vaccines for Children program, pays just $1.99 for a single pediatric dose of MMR (or $3.70 for an adult dose), and the private sector price is just $5.61.
Even those costs are not ones that consumers would have to pay, however. The MMR vaccine is one of many immunizations included under the Affordable Care Act’s essential benefits, which means that the vaccine is fully covered without a copay.
It’s long been clear that the risk-benefit calculation from a health and scientific perspective comes down heavily in favor of the vaccine. Measles kills approximately one in 1,000 cases, and it causes brain damage from encephalitis in about two or three per 1,000 cases, not including the individuals who develop pneumonia or other complications. The vaccine, by contrast, most commonly causes no side effects; when they do occur, they are generally limited to fever, joint pain or mild rash. Severe allergic reactions only take place in only one in every 1 million doses.
The cost-benefit calculation in dollars and cents is just as clear-cut.