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| Meningitis vaccine: moral maze | Meningitis vaccine: moral maze |
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| This week, the paralympian Jonnie Peacock added the T44 100m world title to the Olympic gold he won last year. It is 13 years since doctors had to amputate his leg to save his life after he caught meningitis. | This week, the paralympian Jonnie Peacock added the T44 100m world title to the Olympic gold he won last year. It is 13 years since doctors had to amputate his leg to save his life after he caught meningitis. |
| Meningitis comes in many different forms, but it's most commonly caused by a virus or a bacterium. Its victims tend to be infants, or students in hostels and halls of residence for the first time. It is not clear which strain Peacock had, but that was the year the joint committee on vaccine and immunisation took a leap in the dark and introduced the meningitis C vaccine. Its effect was immediate and dramatic. Now, all children, adolescents and young adults are vaccinated against men C and it has almost disappeared as a threat in the UK. | |
| But this week, the same JCVI has decided that there is not enough data to show that a new vaccine, one that could protect against meningitis B in about 75% of cases, would be cost-effective. It can't, at the moment, recommend its introduction. These are fine and difficult judgments to make. To anyone who has encountered meningitis among family or friends, they will be hard to understand. Every parent (and every family GP) dreads the disease. A fifth of infants who get it die, often within 24 hours or less of first falling ill. So do as many as a third of teenagers (the second most at-risk group). In the UK, it affects around 3,400 people a year and more than 300 die. One in three survivors are left with severe disabilities. Jonnie Peacock had at least a dozen operations in the years that followed his amputation. But the JVCI's done the sums, and they don't stack up. | But this week, the same JCVI has decided that there is not enough data to show that a new vaccine, one that could protect against meningitis B in about 75% of cases, would be cost-effective. It can't, at the moment, recommend its introduction. These are fine and difficult judgments to make. To anyone who has encountered meningitis among family or friends, they will be hard to understand. Every parent (and every family GP) dreads the disease. A fifth of infants who get it die, often within 24 hours or less of first falling ill. So do as many as a third of teenagers (the second most at-risk group). In the UK, it affects around 3,400 people a year and more than 300 die. One in three survivors are left with severe disabilities. Jonnie Peacock had at least a dozen operations in the years that followed his amputation. But the JVCI's done the sums, and they don't stack up. |
| The JCVI works to the same strict formula that the National Institute for Health and Care Excellence applies when assessing treatments, running thousands of variables about the cost of the drug, the numbers affected, the impact of the disease. On the one hand, there is the uncertainty about how the vaccine should be used – at what age, and how many doses and how many boosters. There are questions about its effectiveness. It doesn't work in every case. Immunisation could lead to a misplaced confidence. Even more uncertain is its effectiveness at neutralising the bacteria already carried by many people without showing any symptoms. But then there's the other side of the scale – the human and financial burden of this terrible disease. | The JCVI works to the same strict formula that the National Institute for Health and Care Excellence applies when assessing treatments, running thousands of variables about the cost of the drug, the numbers affected, the impact of the disease. On the one hand, there is the uncertainty about how the vaccine should be used – at what age, and how many doses and how many boosters. There are questions about its effectiveness. It doesn't work in every case. Immunisation could lead to a misplaced confidence. Even more uncertain is its effectiveness at neutralising the bacteria already carried by many people without showing any symptoms. But then there's the other side of the scale – the human and financial burden of this terrible disease. |
| Campaigners mutter that the men C vaccine was a fine judgment too, and that went the other way. But that strain was more common, and occurred in devastating clusters. This vaccine's introduction can't be justified until more is known. Yet unless they go ahead, they never will. A bigger budget? Cheaper drugs? A limited trial among one cohort of adolescents? Something has to give. | Campaigners mutter that the men C vaccine was a fine judgment too, and that went the other way. But that strain was more common, and occurred in devastating clusters. This vaccine's introduction can't be justified until more is known. Yet unless they go ahead, they never will. A bigger budget? Cheaper drugs? A limited trial among one cohort of adolescents? Something has to give. |
| • This article was amended on 25 July 2013. The original stated "Meningitis comes in many different forms, but it's most commonly caused by a virus or a bacteria". This has been corrected. |