Measles were effectively eradicated in much of the western world decades ago, yet the potentially fatal disease has made a fierce comeback in America and Europe due to growing anti-vaccination movements. What are the health costs of enforcing sufficient vaccine coverage in a country? How does a country choose which illnesses to vaccinate against – and how does the Netherlands’ vaccination coverage stand up to the rest of the world?

In this episode of podcast Econ 050, Professor of Global Health Economics Maarten Postma explains how the conversation and science around vaccines has changed in recent decades, and about the costs of medical action and inaction when it comes to inoculation. You can hear the full episode here.

What is health economics?

Maarten Postma: It’s a multidisciplinary research area where obviously it's about health, so medicine is involved, pharmacy is involved and on the other side, economics is involved. It is a discipline that has grown in the last decennia and I think that’s the main component, but there's more. People generally relate health economics to cost effectiveness and analysis in particular of cost effectiveness of new drugs and new vaccines. But it can also be anything else in the health care sector, like surgery. So it's a lot about what do we invest, what are our downstream savings in health care, and what do we gain by that? What are our health gains?

Is the Dutch health care system actually more public or private?

Postma: So the Dutch system has evolved in the last decennia from a mixed system that was private and public towards what is called nowadays a private system, because we have health care insurance companies and they're all basically private companies. It used to be very regionally organized, but nowadays it's more or more competition among the health care insurers on a national level. But still, I think if you look from above to the Dutch system, we say it's private, but there is so much regulation still going on that in a way, you could argue that if you compare it with real private industry, I think the health care system is very regulated and in that sense very publicly regulated.

What does the Dutch immunization programme cover?

Postma: The Dutch vaccination program is a combination of an infant vaccination program and an elderly vaccination program, which is actually the case in many countries. People are starting to think about a lifelong vaccination program. So what about in particular pertussis is one bacteria that also hits at middle age, so there are there are thoughts about a program in between. But presently, it's primarily an infant vaccination program. Talk about measles, pertussis, pneumococcal, meningococcal. Going on to twelve years, there is a girl's vaccination program against cervical cancer.

Traci White: HPV?

Postma: Yes, human papilloma virus, and what is actually now under discussion is whether or not we should include the boys because they can they can transmit it. And it's not only about cervical cancer, but other types of cancer as well, some of which are also in the boys. And then in the elderly, we have an influenza vaccination program going on in the Netherlands. And the decision has just been taken to also start with the pneumococcal vaccination program in the elderly, which is actually something that all countries around us already did for sometimes 20 years.

How has public dialog about vaccination changed over the years?

Postma: I suppose an obvious general tendency is that people are more informed because of the Internet. And that means that people pick up ideas on vaccines from the media much more easily, and these are ideas that are evidence based but also ideas that are not evidence based. You mentioned the autism. This has been indeed an issue for some time and in some countries there was really a drawback already 10 to 15 years ago in some vaccinations. This was based on a study that actually has been retracted in the Lancet released.

White: Yes, thoroughly debunked.

Postma: Some people say it was actually considered as a fraud. But it still pops up.

Which groups in the Netherlands are likelier to be opposed to vaccines, and why?

Postma: It’s quite strict protestant groups in the Netherlands that live in what we call here in the Netherlands in the Bible Belt. So the Bible Belt in the Netherlands stretches from the middle in the direction of Rotterdam, but Rotterdam doesn't belong to it, it stopped somewhere before that. There is the new type of anti-vaccine movement where people who are more from the anthroposophic field, and maybe believes in letting nature doing its own thing.

On how distrust of the profits-driven pharmaceutical industry can translate into scepticism about vaccines:

Postma:This indeed creates an atmosphere of distrust against the pharmaceutical industry. There is a lot to say about the high profits and it has to be looked at, and I think it has that some changes are needed. Transparency in the pharmaceutical industry should be much better… but the side effects of vaccines in the Netherlands, but also in other countries, are monitored very closely.