The bottom line: 42,000 deaths, 20 million cases of disease, and a net savings of $83 billion

That, according to a recent piece in JAMA, is the what the vaccination of each U.S. birth cohort with the current childhood immunization schedule prevents. (That net savings figure is based on a savings estimate of $14 billion — that’s billion, with a b — in direct costs and $69 billion in total societal costs.) All of the attention paid to the MMR, DTaP vaccines, a Hepatitis B vaccines can make it seem as if they’re the only immunizations worthy of discussion. As JAMA point out, that’s definitely not the case:

The impact of two vaccines has been particularly striking. Following the introduction of pneumococcal conjugate vaccine, an estimated 211,000 serious pneumococcal infections and 13,000 deaths were prevented during 2000-2008. Routine rotavirus vaccination, implemented in 2006, now prevents an estimated 40,000-60,000 rotavirus hospitalizations each year. … Age-specific mortality (i.e., deaths per million population) from varicella [chickenpox] for persons age <20 years, declined by 97% from 0.65 in the prevaccine period (1990-1994) to 0.02 during 2005-2007. Average age-adjusted mortality (deaths per million population) from hepatitis A also declined significantly, from 0.38 in the prevaccine period (1990-1995) to 0.26 during 2000-2004.

In addition to vaccine-preventable diseases, the JAMA piece discusses nine other “great public health achievements” in the United States in the first decade of the twenty-first century — including tobacco control, motor vehicle safety, and childhood lead-poisoning prevention. It concludes:

From 1999 to 2009, the age-adjusted death rate in the United States declined from 881.9 per 100,000 population to 741.0, a record low and a continuation of a steady downward trend that began during the last century. Advances in public health contributed significantly to this decline; seven of the 10 achievements described in this report targeted one or more of the 15 leading causes of death. [Related Healthy People 2010 data are available here.] The examples in this report also illustrate the effective application of core public health tools. Some, such as the establishment of surveillance systems, dissemination of guidelines, implementation of research findings, or development of effective public health programs, are classic tools by which public health has addressed the burden of disease for decades.

Although not new, the judicious use of the legal system, by encouraging healthy behavior through taxation or by shaping it altogether through regulatory action, has become an increasingly important tool in modern public health practice and played a major role in many of the achievements described in this report. The creative use of the whole spectrum of available options, as demonstrated here, has enabled public health practitioners to respond effectively. Public health practice will continue to evolve to meet the new and complex challenges that lie ahead.

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