The public health impact of vaccination programmes in the Netherlands: A historical analysis of mortality, morbidity, and costs

Vaccination programmes are one of the most important public health development of the 20th century. Yet, how much have they actually impacted mortality, morbidity, and health care expenditure in the Netherlands? We collected and digitized large amounts of historical data on mortality, morbidity and costs. Our data go back to the early 20th century. Using statistical analyses, we looked at ‘what would have happened if vaccination programmes had not been implemented?’ By answering this question and comparing the results with what actually happened, we get an impression of the impact of vaccination programmes. We mainly focussed on the 20th century and on the ‘older’ vaccination programmes: diphtheria, pertussis, tetanus, polio, measles, mumps and rubella.
While mortality was already declining before vaccination programmes started, they have certainly further reduced childhood mortality: vaccination programmes have averted between 6- and 12-thousand deaths among those born between 1953 and 1992. Vaccination programmes also greatly reduced the number of disease cases reported, ranging from 50% for rubella to 90% for polio. The total expenditure on programmes increased from €5 million in 1957 to €93 million in 2014, mainly due to new and more expensive vaccines. This is still, however, only a fraction of the total government health care spending.
Vaccination programmes have saved and continue to save many lives and avert much suffering. We should however recognise that past performance is not indicative of future (or even current) results. Monitoring the impact of vaccination programmes and highlighting their importance to public health remains paramount.