The Economic Case for Vaccination

Director-General of the World Trade Organization Dr. Ngozi Okonjo-Iweala says investing in preventive health, including vaccines, makes economic sense.

©WTO/Stephane Peyrolo

One of the world’s top economists and former Minister of Finance for the Federal Republic of Nigeria, Dr. Ngozi Okonjo-Iweala is adept at analyzing investments. Currently Director-General of the World Trade Organization, Dr. Okonjo-Iweala is also passionate about global public health and its impact on quality of life and all levels of economic measurement. Recently , she spoke with Sabin’s Anuradha Gupta about the economic case for preventive health measures, such as vaccines and the global effort to eliminate cervical cancer.

What is the economic case for eliminating cervical cancer?

First, of course, it’s important to save lives. But from an economic perspective, it’s really important because of the contribution of women to the household economy, the local economy, the national and global economies. There is a breathtaking statistic:  if women were to have the same opportunities as men to contribute globally, we would add another $28 trillion to the global economy. Imagine if we save these women’s lives, you can quantify just how much they will add not only to their own household, but to the international and global economy. That’s why it is so important not to forget the economic aspects of what we are dealing with in cervical cancer.

At a time when countries are fiscally stretched, what is an economic argument for health prevention over so many other pressing demands?

If you look at what would be saved and what would be added to the national and global economy by acting early to prevent this cancer by vaccinating girls, it’s just incredible. Looking at the fiscal resources, I think it is wiser to invest in the girls’ health now. Number one, to have them avoid getting cervical cancer and, two, to have them healthy so that they can contribute to their household and national economies. Because of the very, very important contribution of women to the economy.

Are you talking about working women?

Just take for example household education of children. If you have a healthy girl who turns into a healthy mother who goes to school, it has repercussions all the way down the line as to how many children they have in the household. They are better able to plan their families, to send their children to school. They are better educated. And therefore, ultimately, the contribution to the economy is higher.  For all these reasons, when I was a minister of finance myself, I thought that prioritizing health and preventive care of girls is a particularly important thing to do from a national point of view.

 

There are certain parts of the WHO’s cervical cancer elimination strategy that are relatively better funded, like the HPV vaccine. But screening also a critical pillar and so is treatment of pre-cancerous lesions.  What will it take to get governments crafting a holistic cervical cancer elimination strategy?

To be very honest, I do not think we’ve been able to present the numbers in a way that we can convince finance ministers and other decision makers that investing early is the most important thing. If we could show just how little it costs to have the screening, to pay for screening and for preventative care and early care, compared to when you have the burden of the cancer. If you look at the two sets of costs and the rate of return on preventive and early care, I think one can easily see what the smart thing is to do. Like I said earlier, as a finance minister I found I’d rather put our money on as much of the early care and preventive care.

Is it important to engage finance ministers?

We must engage finance ministers as well as health ministers on some of these numbers. A health minister’s perspective is “you must finance this, it’s a right.”  But finance ministers have other metrics. To cut a long story short, I think we need to do our homework better. We need to present the results we have. How much does it cost if you are going to do the screening and prevention? What would it cost if you didn’t do that and a number of the girls and women felt the burden of the cervical cancer and you had to treat them? I think when we present these numbers and have this discussion, it will be very clear to fiscal authorities that they better put aside money for prevention rather than wait to deal with the disease.

You have been in the forefront of this whole conversation about distributed manufacturing, where essential health commodities are produced on every continent. How hopeful are you that the vision that you have painted will reach fruition?

I’m quite hopeful. It’s amazing to me how that message resonates in two ways. One, because businesses are making the decisions themselves that having this distributed, decentralized, and diversified manufacturing base really truly helps them build resilience, so they buy into what we call re -globalization at the WTO. Secondly, I’ve seen domestic investors also respond to this call and look for partnerships for manufacturing health commodities at home. In fact, I can tell you that two weeks ago I was back in Nigeria helping to launch the second phase of a medical manufacturing facility. The first phase is producing IV fluids with state -of -the -art equipment. And the next is for vaccines and therapeutics. I think the message is being heard domestically and investors are investing.  Now, will it be easy? The answer is no. But all in all, I’m quite excited that it’s happening.

India could soon have diversified manufacturing for all kinds of essential commodities…

India is a generic manufacturing powerhouse of the world. We are also hoping that Indian manufacturers will diversify to other developing countries.

Dr. Ngozi Okonjo-Iweala meets Prime Minister Xanana Gusmão of Timor-Leste at the World Economic Forum Annual Meeting 2024 in Davos, Switzerland. Photo ©WTO
You have extensive personal experience engaging young people. What are some best practices for helping them become advocates for their own health and agents of wider change?

It’s always been a delight to engage with young people. We had several programs when I was finance minister, such as Growing Girls and Women, which we call G -WIN, and the U -WIN program, Youth Enterprise with Innovation. These were started from the point of view that investing in women is good economics, and investing in girls is even smarter economics. If you can catch them earlier as adolescents, you can educate them as to what is the right thing to do and you can help them with preventative healthcare. They can become big advocates once they understand how important these are.

You have a family of doctors. You are an economist, but your husband and children are doctors. You understand how health systems operate, the strengths and challenges. What is your message to women?

I really have a strong message to women: you have to take time to invest in yourself and in your health. Take some time out to make sure that you get all the training and preventive care you can, because early action saves lives. And I’m saying this to women because they are so busy taking care of their household, their husbands, the extended family, that are working in the house that they often don’t stop to think about themselves. So you are precious. Take time to invest in yourself.

What is your biggest hope for the future of women’s health worldwide?

Vaccines, I think, are miracles. Every time a new vaccine is invented that tackles a new disease, I think it’s a miracle. My hope and my dream for women is that can we find those miracle drugs or vaccines like the HPV vaccine that can tackle a lot of the diseases women face, like breast cancer, which is becoming more and more common even in developing countries. Can we find vaccines that will tackle women’s health issues so girls can just take one shot and they’re safe? That’s my dream for women. Then we don’t have to worry about healthcare anymore.

Watch the Getting to Zero Episode with Dr. Ngozi