While the cost-per-QALY framework is unquestionably a useful one in framing and addressing questions of value for money, this metric may not reflect our preferences (e.g., in terms of risk aversion or distribution of health outcomes) as individuals or a society.

Such limitations warrant a serious reexamination of how cost-effectiveness thresholds should be applied in healthcare decisions.

This is especially important when these decisions concern the use of pediatric vaccines against rare and unpredictable diseases.