The costs of measles

[© UNICEF/Giacomo Pirozzi A young boy receives a measles immunization in Osh city in southwestern Kyrgyzstan]

A few days ago, I noticed the outbreak of measles in the US (reference 1), in the course of which I turned up a paper about the cost of a measles outbreak in the UK (reference 2). On a quick glance, I was uneasy about these costs, worrying about the possibility of double counting of medical costs. I have now taken another look.

The focus of the paper at reference 2 is the costs of a measles outbreak in the Liverpool area 2012-2013, but the wider context is the cost of prevention, that is to say full-on immunisation of children and others, compared to the cost of an outbreak. The accepted wisdom of those involved is that the former are small compared with the latter and that full-on immunisation is a good plan. With another bit of wisdom being that with full-on immunisation there would be no outbreaks.

Immunisation costs

In the context of the Liverpool outbreak, what a full-on immunisation programme would have cost is estimated at something under £200,000 and would have involved something under 12,000 MMR shots. Regarding which Copilot tells me that ‘the MMR vaccine protects against measles, mumps, and rubella, and is recommended for children to prevent these serious viral diseases’.

A full-on immunisation programme involves giving two shots to everyone, other than those who are too young , those who are unsuitable for some other reason and those who have already been immunised. 95% coverage of the population is good enough and it has usually been possible to achieve this (in rich countries) without compulsion, allowing, as it were, for conscientious objectors.

If one were to suppose that one shot in a thousand went badly wrong, incurring significant costs, perhaps hundreds of thousands of pounds per case, the cost of such a programme would be massively increased.

One needs to be careful with information about this sort of thing, with adverse reports being apt to be amplified by social media and to have a bad effect on immunisation rates. That said, the accepted wisdom seems to be that, for any one person, the risks associated with being immunised are much smaller than those associated with not being immunised. That the risk of a shot going wrong is much, much less than one in a thousand.

Reference 2 does not address this side of things.

The scope of the model

One of the dimensions of analysis used in the paper is treatment, control and society. The costs of treatment of those who catch measles, the costs of control of the outbreak and the opportunity cost of those who catch measles or who care for someone who had. The cost of the lost days of work.

All of these costs are incurred once one has an outbreak in a rich country like ours: you have to treat, you have to control and there are knock-on costs. Maga and Reform notwithstanding.

It was the first two items in society section of the edited version of Box 1 above which first caught my eye – secondary and primary care costs. Having already counted costs in the treatment section, was it right to be counting them again here?

The boxed texts give an alternative name to the broad category and the orange spots mark those costs which have been include in the analysis. At least as far as I could see.

On further inspection, my verdict was that if what was meant was the cost of delays in treatment to those bumped by the measles outbreak, the cost to me of my treatment for something or other – not measles – being delayed, then it was not double counting. But it would be difficult to quantify and as far as I could see, was not included in this analysis anyway. In the same way as it would be difficult to quantify the cost to an ill child of missing school days. And then, what about the matching gain to all those children in slightly smaller classes?

For those who like graphics, Boxes 2 and 3 are much bigger and better, if a bit hard to grapple with on a small screen.

Bringing together different dimensions

Table 2 and table 4 use different dimensions again and I have attempted a reconciliation of what turn out to be the large numbers in the graphic above. 

The acronym CMHPU does not appear anywhere else in the paper, but yesterday Bing told me that ‘CMHPU, in the context of measles, refers to 'Centres for Measles and Rubella Prevention and Control'. This organisation focuses on the prevention and control of measles and rubella, providing guidance and resources for healthcare professionals and the public' – which fits. While today, on the same or on a similar key, he focuses on a quite different aspect of the matter. In the same vein, the terms ‘closure’ and ‘delay’ in Box 1 do not occur elsewhere in the paper.

Note that the three column totals are all, individually, a good deal bigger than the cost of an immunisation programme, and it would need major surgery to disturb the cost justification for this last. Subject to the inevitable response from those holding the purse strings, that it is not always easy – or even possible – to spend money today to save money tomorrow. Particularly when a near half of the savings claimed fall to private funds rather than to central funds.

Conclusion

The paper at reference 2 is not very well written, but enough has been done to make the case. All things considered, it would perhaps not have been worthwhile to have done a better job on it. However, given the current situation in the US and the potential for flare-ups on social media, maybe it would be well to do more now.

It may well be that there are better papers out there already – but I have not looked again.

PS 1: not to be outdone by Microsoft and Bing, Adobe (the people who do the Acrobat pdf reader) offer the following: ‘This appears to be a long document. Save time by reading a summary using AI Assistant’. An open invitation for authors to be careless, in the knowledge that AI will tidy things up for them? I have not tried it. Not yet, anyway.

PS 2: I have just stumbled upon an interesting complement to the assisted dying debate (which drags on, unhelpfully, in our House of Lords) at reference 4. With my recent holiday adding spice. Inter alia, another case of spend now to save later.

References

Reference 1: https://psmv6.blogspot.com/2026/02/measles.html. 

Reference 2: The economic cost of measles: Healthcare, public health and societal costs of the 2012–13 outbreak in Merseyside, UK – Sam Ghebrehewet, Dominic Thorrington, Siobhan Farmer, James Kearney, Deidre Blissett, Hugh McLeod, Alex Keenan – 2016. At file:///C:/Users/jimto/Downloads/measles_costing.pdf. 

Reference 3: https://www.cdc.gov/vaccine-safety/vaccines/mmr.html. Last updated: 31 July 2024? That is to say, before the arrival of the current United States secretary of health and human services. Which I think is roughly equivalent to the late lamented DHSS here.

Reference 4: We must change our conception of palliative care: The NHS is ill-equipped to deal with the needs of a growing and ageing population - Sarah Holmes, Financial Times - 2026.

Reference 5: https://www.dignityindying.org.uk/.