Immunize.org

Ordinary unrestricted recipient support retains all programs, fundraising, administration, merchandise cost and investment-management costs. C=3247254 is FY 2025 tax functional expense plus 65922 COGS, a non-donated-service expense anchor, not cash flow or marginal cost. Annual financial series additionally includes 81792 recognized donated services in 2025. Donated information, external clinician implementation labor, vaccines and administration are not free societal resources. G=10000 is normalization only.

USA residents of 50 states andDC are the target. US clinical schedules, domestic coalitions and practice guidance support a predominantly domestic pathway, but the public websites and global policy advising also reach abroad. FY 2025 ScheduleF records 26524 international guidance expense inEastAsia/Pacific andEurope; that expenditure percentage does not measure health share. Conditional g=.95, stress.8–.99, is a judgment for the older-adult influenza pathway, not observed outcome attribution. Other geography and vaccine pathways remain unquantified.

At annual recipient scale, N=K×V×delta additional at-visit influenza doses from otherwise-attributable implementations. q=tau×(rD×e×L+rH×e×qH+rI×e×qI)−h net QALY per dose. Q_all=(G/C)×b×N×q + Q_other; Q_USA=Q_all×g in conditional homogeneous-geography tests. Price=10G/Q_USA if positive. Central b, K and g are judgments; other health remains unpriced. K discounts adoption that equivalent freely available guidance would cause anyway; b separately discounts donor/sponsor replacement or reserve financing. tau discounts later alternative vaccination and incomplete seasonal protection. h is incremental adverse burden relative to the actual alternative; under identical timely replacement vaccination both incremental protection and incremental harm are zero. Conditional cases set Q_other=0, not as a lower-bound claim.

G

10000 USD normalization (judgment). Arithmetic only.

FY2025 tax functional expense

3181332 USD (observed). PartIXallfunctions; COGS excluded by tax-form convention. [imm-tax25]

FY2025 cost of goods sold

65922 USD (observed). PartVIII 10 b andScheduleD; restored once. [imm-tax25] [imm-d25]

FY2025 donated services

81792 USD recognized resource value (observed). ScheduleDreconciliation; annualgross series includes it, support-dollar benchmark excludes it. [imm-d25]

C

3247254 USD per annual recipient scale (judgment). 3181332+65922. All recipient functions retained. Alternative recognized-resourceC 3329046. Not a marginal cost quote. [imm-tax25] [imm-d25]

b

0.25 funding-sensitive additionality (judgment). We choose 100 otherwise-attributable practice implementations per annual cost equivalent, rather than the earlier 1,000-case probe. For scale, this is 0.2% of roughly 50,000 subscribers; subscribers are not unique practices and this is not measured conversion. The small conversion allows passive use, duplication and equivalent free guidance. A further 25% funding response allows reserves and substitution. Other vaccine health remains unpriced. [imm-tax25] [imm-funding]

K

100 otherwise-attributable practice implementations per annual scale (judgment). We choose 100 otherwise-attributable practice implementations per annual cost equivalent, rather than the earlier 1,000-case probe. For scale, this is 0.2% of roughly 50,000 subscribers; subscribers are not unique practices and this is not measured conversion. The small conversion allows passive use, duplication and equivalent free guidance. A further 25% funding response allows reserves and substitution. Other vaccine health remains unpriced. [imm-highlights] [imm-evaluation]

V

1000 eligible age65+patients per practice-season (judgment). Hypothetical practice scale;500–2000 stress. Recipient-linked patient denominator absent. [flu-workflow-rct]

delta

0.03 additional at-visit doses per eligible patient (judgment). Three percentage points: below modern 5.1-point intensive workflow result. Recipient influenza site changes ranged−2 to+6 points, uncontrolled; test 0–.08. [imm-poster] [flu-workflow-rct] [flu-standing-rct]

rD

0.0006 unvaccinated influenza deaths per older adult-season (judgment). 60/100000 hypothetical future-season risk, anchored only broadly to substantial older-adult burden in 2024–25. Not an observed unvaccinated recipient risk. Stress 0–.001. [flu-burden25]

rH

0.006 nonfatal influenza hospitalizations per older adult-season (judgment). Mutually exclusive nonfatal severe category; lower than some high-season burden, not claimed observed. Stress.002–.01. [flu-burden25]

rI

0.05 nonhospital influenza illnesses per older adult-season (judgment). Separate nonfatal mild category to avoid double-counting hospital/death episodes. Stress.02–.10. [flu-burden25]

e

0.3 relative prevention of modeled outcomes (judgment). Approximately 2025–26 older-adult hospitalization VE 31%; transferring to mortality and mild illness is uncertain. Tests.15–.5; mortality-zero sensitivity separate. [flu-ve26] [flu-method]

L

5 discounted remaining QALYs per death prevented (judgment). Allows older age/comorbidity and future 3%discounting; not life expectancy for all older adults. Stress 3–8; no additional survival duration multiplier.

qH

0.015 QALY per nonfatal hospitalization avoided (judgment). About 5.5 quality-adjusted days; acute morbidity only, no unmeasured long-term effect.

qI

0.005 QALY per nonhospital illness avoided (judgment). About 1.8 quality-adjusted days; acute illness only.

tau

0.5 incremental season-protection fraction (judgment). Accounts for later catch-up vaccination, timing and imperfect overlap with risk period. Not vaccine efficacy a second time. Stress 0–.8. [flu-method] [flu-workflow-rct] [flu-medicare]

h

0.00005 QALY adverse burden per extra dose (judgment). Incremental transient symptoms, administration burden and rare adverse events relative to actual alternative care; not an observed aggregate utility loss. Under identical timely replacement, h=0. Other stress tests use 0.00002–0.0001. CDC's rare Guillain–Barré risk is not this utility quantity. [flu-safety]

g

0.95 USA resident health share (judgment). We choose 100 otherwise-attributable practice implementations per annual cost equivalent, rather than the earlier 1,000-case probe. For scale, this is 0.2% of roughly 50,000 subscribers; subscribers are not unique practices and this is not measured conversion. The small conversion allows passive use, duplication and equivalent free guidance. A further 25% funding response allows reserves and substitution. Other vaccine health remains unpriced. [imm-about] [imm-f25]

Q_other

0 additional QALYs from other recipient pathways (judgment). We choose 100 otherwise-attributable practice implementations per annual cost equivalent, rather than the earlier 1,000-case probe. For scale, this is 0.2% of roughly 50,000 subscribers; subscribers are not unique practices and this is not measured conversion. The small conversion allows passive use, duplication and equivalent free guidance. A further 25% funding response allows reserves and substitution. Other vaccine health remains unpriced. [imm-highlights]

Best estimate — explicit judgment: Cost: $10K; USA QALYs: 0.0009895668771214077; all-population QALYs: 0.0010416493443383239. C=3247254; b=0.25; K=100; V=1000; delta=0.03; rD=0.0006; rH=0.006; rI=0.05; e=0.3; L=5; qH=0.015; qI=0.005; tau=0.5; h=0.00005; g=0.95. One influenza season only, age65+; q=0.000451; additional doses=2.309643779020674. K is a hypothetical incremental implementation count, not observed downloads or honor-roll members. We choose 100 otherwise-attributable practice implementations per annual cost equivalent, rather than the earlier 1,000-case probe. For scale, this is 0.2% of roughly 50,000 subscribers; subscribers are not unique practices and this is not measured conversion. The small conversion allows passive use, duplication and equivalent free guidance. A further 25% funding response allows reserves and substitution. Other vaccine health remains unpriced.

Conditional older-adult influenza implementation test: Cost: $10K; USA QALYs: 0.009895668771214077; all-population QALYs: 0.010416493443383239. C=3247254; b=0.25; K=1000; V=1000; delta=0.03; rD=0.0006; rH=0.006; rI=0.05; e=0.3; L=5; qH=0.015; qI=0.005; tau=0.5; h=0.00005; g=0.95. One influenza season only, age65+; q=0.000451; additional doses=23.09643779020674. K is a hypothetical incremental implementation count, not observed downloads or honor-roll members.

Large timely high-yield implementation: Cost: $10K; USA QALYs: 3.7755469698397484; all-population QALYs: 3.8136838079189377. C=3247254; b=0.75; K=3000; V=2000; delta=0.08; rD=0.001; rH=0.01; rI=0.1; e=0.5; L=8; qH=0.015; qI=0.005; tau=0.8; h=0.00002; g=0.99. One influenza season only, age65+; q=0.0034400000000000008; additional doses=1108.6290139299235. K is a hypothetical incremental implementation count, not observed downloads or honor-roll members.

Weak implementation in mild season: Cost: $10K; USA QALYs: -0.00001033180650481915; all-population QALYs: -0.000012914758131023936. C=3247254; b=0.1; K=100; V=500; delta=0.01; rD=0.0001; rH=0.002; rI=0.02; e=0.15; L=3; qH=0.015; qI=0.005; tau=0.25; h=0.0001; g=0.8. One influenza season only, age65+; q=-0.000083875; additional doses=0.1539762519347116. K is a hypothetical incremental implementation count, not observed downloads or honor-roll members.

Existing support or materials suffice: Cost: $10K; USA QALYs: 0; all-population QALYs: 0. C=3247254; b=0; K=1000; V=1000; delta=0.03; rD=0.0006; rH=0.006; rI=0.05; e=0.3; L=5; qH=0.015; qI=0.005; tau=0.5; h=0.00005; g=0.95. One influenza season only, age65+; q=0.000451; additional doses=0. K is a hypothetical incremental implementation count, not observed downloads or honor-roll members.

Only nonfatal illness benefit: Cost: $10K; USA QALYs: 0.000021941615900696192; all-population QALYs: 0.00002309643779020652. C=3247254; b=0.25; K=1000; V=1000; delta=0.03; rD=0; rH=0.006; rI=0.05; e=0.3; L=5; qH=0.015; qI=0.005; tau=0.5; h=0.00005; g=0.95. One influenza season only, age65+; q=9.999999999999904e-7; additional doses=23.09643779020674. K is a hypothetical incremental implementation count, not observed downloads or honor-roll members.

Identical timely vaccination elsewhere: Cost: $10K; USA QALYs: 0; all-population QALYs: 0. C=3247254; b=0.25; K=1000; V=1000; delta=0.03; rD=0.0006; rH=0.006; rI=0.05; e=0.3; L=5; qH=0.015; qI=0.005; tau=0; h=0; g=0.95. One influenza season only, age65+; q=0; additional doses=23.09643779020674. K is a hypothetical incremental implementation count, not observed downloads or honor-roll members. Shared vaccine burden cancels; these are displaced doses, not additional administrations.

Counterfactual: Existing clinic workflows, electronic-record vendors, professional societies, CDC guidance and other coalitions can substitute for Immunize.org materials. Templates already online may remain available without a new gift. K must count implementation actually induced, not honor-roll enrollment, pageviews or workshop attendance. b handles funding source replacement separately. Medicare already covers seasonal flu vaccine without patient payment at participating providers; clinical access and workflow can still limit receipt. tau allows later vaccination elsewhere and dose timing. No public-payer savings are converted to health. Identical timely vaccination elsewhere has the same ordinary adverse effects: set tau=0 and h=0. Negative probes require genuinely additional ineffective or duplicate doses, not shared counterfactual harms.

Attribution: All recipient cost is retained while the conditional health calculation considers only older-adult influenza. Other vaccines, policies, translated safety information and reduced errors may matter greatly, but require separate age/pathogen-specific clinical bridges and counterfactuals. No generic vaccine QALY coefficient is applied to all output. No herd-immunity multiplier, indefinite recurring practice benefit, honor-roll causation, saved healthcare dollars or productivity is credited. Autonomy and consent concerns in policy advocacy are not erased by this narrow clinical calculation.

We choose 100 otherwise-attributable practice implementations per annual cost equivalent, rather than the earlier 1,000-case probe. For scale, this is 0.2% of roughly 50,000 subscribers; subscribers are not unique practices and this is not measured conversion. The small conversion allows passive use, duplication and equivalent free guidance. A further 25% funding response allows reserves and substitution. Other vaccine health remains unpriced. Zero and adverse outcomes remain possible; the quantified pathway is not a complete portfolio valuation.

Sensitivity

• At conditional q=.000451 and g=.95, recipient support must produce at least one net additional at-visit dose per $42.845 to meet $1 million/10, or per $4.2845 to meet $100000/10. The timing/alternative-protection discount tau is already inside q; do not apply it twice.
• Conditional implementation assumptions yield about $10.1 million/10. Favorable large-scale inputs yield about $26000; weak seasonal benefit and no marginal implementation remove the positive price. This wide span is not a claimed confidence interval.
• With V 1000, delta.03, b.25 and cautious q, K must be≥10105 annual attributable implementations for $1 million/10 or≥101054 for $100000/10. No observed denominator supports either target. Larger practices, more vaccines or durable effects could change this but require evidence.
• Restoring $81792 recognized donated services increasesC and conditional price by 2.52%. Including an illustrative $50 external vaccine/administration cost peradditionaldose adds approximately $1.17 million per 10 USAQALYs at cautious q. That is a sensitivity, not an actual procurement price; patient/provider opportunity costs remain.
• Without modeled mortality benefit, acute morbidity benefit nearly cancels the adopted transient adverse allowance. This exposes reliance on event-risk, mortality-effect and remaining-health assumptions, rather than proving poor clinical vaccination value.
• For identical timely vaccination elsewhere, tau=0 and incremental h=0, so net health change is zero. Harm can remain when an ineffective or duplicate dose is genuinely additional, not merely obtained from a different provider.
• One season only is credited. Multi-year workflow persistence would need continued use, vaccine updates, personnel continuity and protection against counting the same implementation again in later fundraising.
• Do not treat FY 2025 foreign expense 26524/totalexpense as the USA health fraction, or apply older-adult influenza q to HPV, hepatitisB, meningococcal or childhood vaccines.
• Honor rolls may improve practice incentives, but existing high-coverage institutions self-select. Prevented outbreaks or policy losses require causal probability and affected-population models, not a count of recognitions.

Unresolved inputs

• Current funding-contingent operating plan and reserve/sponsor commitments showing which guidance, implementation support or policies change if ordinary donations change.
• Deduplicated practice cohort with verified baseline workflow, material use, actual implementation and comparison against equivalent free guidance or routine quality improvement.
• Vaccine-, age-, risk- and season-specific additional completed doses, including off-site/catch-up vaccination and changes in denominators or record linkage.
• USA 50 states/DC resident outcomes and global guidance attribution; not visitorIPorforeignexpenseproxies.
• Clinical event risks for marginal vaccine recipients, causal severe/mortality effectiveness, remainingquality-adjusted survival, timing and adverse burden.
• Full downstream vaccine/administration and provider implementation costs, competing clinical work and public/private financing substitution.
• A separate net-health model for other vaccines, safety guidance, policy work and birth-dose/honor-roll incentives; prevent overlap with standing-order effects.
• Latest audit/control remediation, current industry/public funding concentration and explanation of differing 2025 download totals.