OBJECTIVES: . Since the beginning of the new millennium, prices of vaccines have been increasing significantly, reflecting decades of  research and development.  As they have done with pharmaceuticals, governments have begun to incorporate economic considerations into scientific reviews.  Vaccines fall into the public health category,  whose ethic differs historically from that in the pharmaceutical market.   The purpose of this paper is to review how countries have incorporated economics into the scientific vaccine review process. METHODS: . We contacted experts in countries which had scientific review committees according to the VENICE website, and the USA, Australia, New Zealand,  and Hong Kong.  We asked a series of questions regarding the structure of the review process, the role of economics, and the economic criteria used. RESULTS: .  We obtained information from ten countries which used economics in their vaccine scientific reviews.  In terms of structure, reviews fell into two groups – those which incorporated economics into the scientific review (GB, FI, FR, HK, NL, NZ, US) and those which separated economic and clinical considerations (SW, AU). The criteria  used in economic studies followed the pharmaceutical guidelines in all instances. CONCLUSIONS: . Pharmaco-economics has grown up in the world of pharmaceuticals, not in the public health arena. The ethics in these two arenas differ. Certain elements – epidemiological considerations, herd immunity, long effect times – are relevant to vaccines.  Using pharmacoeconomic rules for vaccines may not create a level playing field.