In the 1980s, drug prices began rising considerably worldwide, and in the 1990s, countries began incorporating health economics into the scientific review process. Rising prices in vaccines began around the year 2000 and national bodies began to use health economics to review vaccines in the next decade. Health economics is a discipline that evaluates alternative interventions, balancing costs and health outcomes. There are characteristics of infectious diseases that differ from other illnesses, most notably the herd effect. We reviewed the role of economics in conducting vaccine scientific reviews. We conclude that health economics can move some of the considerations in vaccine policy decision-making from the political to the scientific arena, but there are still many unresolved issues. Health economists will continue to address these issues in the coming years, but there will always be a need for a separate policy review.