COVID vaccine policy: Penny-wise, pound-foolish

Dear Members, 

The Government of Alberta has referred to COVID-19 vaccines as “an expensive intervention.” This perspective is being used to justify a vaccine policy based (confusedly) on pre-ordering, radically reduced community access and charging most Albertans to receive the vaccine.

We thought we should check the facts. Here’s a report from our analysts, but let me give you some highlights showing why vaccination is one of our most cost-effective interventions:

• In 2023-24, unvaccinated Albertans were nearly 10 times more likely to be hospitalized for COVID-19 than those fully vaccinated, and 20 times more likely than those with a booster.
• Higher vaccine uptake could have prevented approximately 3,400 hospitalizations, 36,300 bed-days and $100 million in direct health care costs.

Compare a single dose of vaccine at $100 against more than $34,000 per hospitalization. Put another way, instead of paying for one COVID hospitalization, Alberta could vaccinate about 310 people, who will then enjoy better health, productivity and quality of life, while not contributing (avoidably) to overloaded emergency rooms and in-patient facilities. We can clearly state: Vaccination offers a strong return on investment.

Considering recent barriers to vaccine access and ongoing misinformation/disinformation discouraging uptake, we also wondered about the cumulative costs of people being deterred from getting vaccinated. You’ll find the numbers here. This table illustrates the potential financial consequences of implementing a policy that charges $100 for a COVID-19 vaccine. It presents scenarios in which 1%, 5%, 10%, 15% or even 20% of the population forgo vaccination due to the added cost, other barriers to access or misinformation about the benefits of immunization. In a province with over 5 million people, it's not unreasonable to expect that at least 5% — or 250,000 people — could be deterred simply because they cannot afford it.

The modelling also explores varying levels of infection risk, reflecting how contagious the circulating COVID-19 strain might be. For context, a recent CBC article reported that Alberta’s wastewater surveillance showed a test positivity rate of 16.9% in August 2024. This suggests that a 15% infection risk is credible.

Given increased infection risk and taking a cautious approach, let’s look at a very plausible situation. If only 5% of Albertans are deterred from getting vaccinated, the projected additional health care costs exceed $65 million in hospitalization costs alone. This far surpasses any savings the province might achieve through spending less on vaccines or minimizing wastage.

COVID-19 is still a serious health issue in Alberta, especially for seniors and people with existing health conditions. They’re more likely to end up in the hospital or face long-term complications, not to mention other non-hospital medical costs, missed work/lost productivity, etc. With Alberta’s population growing and more people moving in, emergency rooms and health care services are feeling the strain.

The goal of a vaccination program is not to manage supply, but to predict how many people in the population would benefit from the prevention therapy; order the appropriate supply to meet these needs; and reduce/eliminate any barriers that might reduce uptake of the proven prevention therapy. Albertans deserve public health services grounded in the best evidence available to reduce long- term costs and health burdens. Any and all barriers to delivering proven vaccines to those who need them is a failing of public health — not a waste of an unused vial.

Regards,

Brian Wirzba, MD, FRCPC
President, Alberta Medical Association