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You can find the current article at its original source at http://www.theguardian.com/commentisfree/2016/feb/24/meningitis-b-vaccine-petition-nhs-not-cost-effective
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| For a cash-strapped NHS, extending the meningitis B vaccine isn’t cost-effective | For a cash-strapped NHS, extending the meningitis B vaccine isn’t cost-effective |
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| The recent distressing images in the news of severely ill children are a potent reminder of the devastation caused by meningitis and septicaemia (blood poisoning) and confirm why this disease is so feared. Thankfully, cases like this are now significantly less common due to the introduction in the UK over the past 24 years of vaccines against three of the common causes. Since 2015, a further vaccine has been offered to adolescents in response to a rise in cases of a particularly virulent strain. | The recent distressing images in the news of severely ill children are a potent reminder of the devastation caused by meningitis and septicaemia (blood poisoning) and confirm why this disease is so feared. Thankfully, cases like this are now significantly less common due to the introduction in the UK over the past 24 years of vaccines against three of the common causes. Since 2015, a further vaccine has been offered to adolescents in response to a rise in cases of a particularly virulent strain. |
| Last year yet another vaccine was included in the armamentarium against this terrible condition: MenB. This particular vaccine took many years to develop, due to characteristics of the bacteria that meant it could not be made in the same way as the existing ones. It also took two years from the vaccine being licensed for its introduction to be agreed upon, with its use approved for infants aged two and four months with a booster at 12 months. | Last year yet another vaccine was included in the armamentarium against this terrible condition: MenB. This particular vaccine took many years to develop, due to characteristics of the bacteria that meant it could not be made in the same way as the existing ones. It also took two years from the vaccine being licensed for its introduction to be agreed upon, with its use approved for infants aged two and four months with a booster at 12 months. |
| Related: Why is the meningitis vaccine funded only for babies and are there any risks? | Related: Why is the meningitis vaccine funded only for babies and are there any risks? |
| Following recent publicity of older children affected by meningococcal disease, a petition calling for MenB vaccine to be offered to all children up to 11 years old has been signed by more individuals than any other in UK parliamentary history in the space of only a few days. Seeing the graphic images of desperately sick children in the news, it is no surprise that so many signatures have been gathered. No one would wish to deny any child protection against such a dreadful illness, which can not only kill a previously healthy child in a matter of hours, but can result in life-changing complications such as limb amputations. | Following recent publicity of older children affected by meningococcal disease, a petition calling for MenB vaccine to be offered to all children up to 11 years old has been signed by more individuals than any other in UK parliamentary history in the space of only a few days. Seeing the graphic images of desperately sick children in the news, it is no surprise that so many signatures have been gathered. No one would wish to deny any child protection against such a dreadful illness, which can not only kill a previously healthy child in a matter of hours, but can result in life-changing complications such as limb amputations. |
| If only it were that straightforward. Before any vaccine is introduced, it is carefully assessed to make sure it is safe, it works and it provides good value for money. Although this latter consideration seems hardhearted and cruel, resources are limited and they have to be used carefully. If a new vaccine, or any other health intervention, is introduced, either something else funded from the public purse will have to be cut, or taxes increased. | If only it were that straightforward. Before any vaccine is introduced, it is carefully assessed to make sure it is safe, it works and it provides good value for money. Although this latter consideration seems hardhearted and cruel, resources are limited and they have to be used carefully. If a new vaccine, or any other health intervention, is introduced, either something else funded from the public purse will have to be cut, or taxes increased. |
| In 2013, the Joint Committee on Vaccination and Immunisation (JCVI), the independent scientific committee that advises the government on immunisation, considered the available evidence and concluded that the vaccine was safe and was likely to protect against the disease. However there were other very important unknowns, including how well it might stop the disease spreading. All this was against a background of a recent reduction of cases of meningitis B , from just under 1,700 in 2001 to just over 600 in 2012, in the absence of a vaccination programme. | In 2013, the Joint Committee on Vaccination and Immunisation (JCVI), the independent scientific committee that advises the government on immunisation, considered the available evidence and concluded that the vaccine was safe and was likely to protect against the disease. However there were other very important unknowns, including how well it might stop the disease spreading. All this was against a background of a recent reduction of cases of meningitis B , from just under 1,700 in 2001 to just over 600 in 2012, in the absence of a vaccination programme. |
| Even allowing for a reversal of this fall in the future, the JCVI concluded that on the basis of the information available the vaccine could not be said to be cost-effective. After a period of consultation, taking into account new data and making some assumptions, they concluded that the vaccine would be cost-effective if given only to children aged two, four and 12 months old and if it could be purchased at a price much lower than that on the open market. Giving the vaccine to older age groups would not be cost-effective. Last spring, just before the general election campaign begun, Jeremy Hunt announced that a price had been agreed and the vaccine would be introduced in September. (We don’t know the price, as it is considered “commercially sensitive”.) | Even allowing for a reversal of this fall in the future, the JCVI concluded that on the basis of the information available the vaccine could not be said to be cost-effective. After a period of consultation, taking into account new data and making some assumptions, they concluded that the vaccine would be cost-effective if given only to children aged two, four and 12 months old and if it could be purchased at a price much lower than that on the open market. Giving the vaccine to older age groups would not be cost-effective. Last spring, just before the general election campaign begun, Jeremy Hunt announced that a price had been agreed and the vaccine would be introduced in September. (We don’t know the price, as it is considered “commercially sensitive”.) |
| Related: Meningitis: petition adds to pressure for vaccine for every child | Related: Meningitis: petition adds to pressure for vaccine for every child |
| A quarter of all cases of meningitis B affect children in the first year of life, placing them at highest risk of this disease with a small peak in adolescence. This differs from the pattern of meningitis C, which not only has a large peak in adolescence but a higher death rate in this age group. If the vaccine were to be rolled out to older children and adolescents, even assuming there was enough vaccine and people to give it, it would be very expensive and no longer cost-effective. The NHS is desperately short of money and in the unlikely event that extra money did become available, the question needs to be asked whether it might be better for children, overall, if it were spent on the many other causes of death and disability in the young. | A quarter of all cases of meningitis B affect children in the first year of life, placing them at highest risk of this disease with a small peak in adolescence. This differs from the pattern of meningitis C, which not only has a large peak in adolescence but a higher death rate in this age group. If the vaccine were to be rolled out to older children and adolescents, even assuming there was enough vaccine and people to give it, it would be very expensive and no longer cost-effective. The NHS is desperately short of money and in the unlikely event that extra money did become available, the question needs to be asked whether it might be better for children, overall, if it were spent on the many other causes of death and disability in the young. |
| This decision is not set in stone and will be reviewed as more experience of the vaccine is obtained. Knowing how well the vaccine prevents person-to-person spread of infection is critical. Like other causes of meningitis and septicaemia, meningitis B bacteria are carried in the noses and throats of many healthy people with no ill effect. Carriers can pass the bacteria on to others who, for various reasons, develop the disease. | This decision is not set in stone and will be reviewed as more experience of the vaccine is obtained. Knowing how well the vaccine prevents person-to-person spread of infection is critical. Like other causes of meningitis and septicaemia, meningitis B bacteria are carried in the noses and throats of many healthy people with no ill effect. Carriers can pass the bacteria on to others who, for various reasons, develop the disease. |
| One of the important benefits of the other vaccines used is that as well as protecting vaccinated individuals, they reduce carriage of the bacteria, providing indirect protection to a wider population. When we know how well the vaccine reduces carriage, this might alter the cost effectiveness of the vaccine and make it viable to introduce it for older ages. Meanwhile, we need to be sure that those most at risk – infants – are being protected and that we spend our restricted health budget wisely, based on the scientific evidence available. | One of the important benefits of the other vaccines used is that as well as protecting vaccinated individuals, they reduce carriage of the bacteria, providing indirect protection to a wider population. When we know how well the vaccine reduces carriage, this might alter the cost effectiveness of the vaccine and make it viable to introduce it for older ages. Meanwhile, we need to be sure that those most at risk – infants – are being protected and that we spend our restricted health budget wisely, based on the scientific evidence available. |
| The fee for this article was donated to Meningitis Research and Meningitis Now |