Meningitis B, again!

I’ve written about Meningitis B more than anything else in the last few months. But it has probably been the most high profile “kids and science” topic in the last few years! Last week the petition was finally considered in the House of Commons, and here’s what will probably be my final piece on it for a while. The Meningitis page on the Motherbug website now contains a synthesis of all the information to date! So, in this piece I’ll assume you know the background!

The final debate in the House of Commons was interesting, if a little long and repetitive. It’s the first time I’ve watched a Commons Debate, and the ceremonial bits were interesting. I marvelled at phrases like “I would like to salute Dr Edward Jenner, who worked on the smallpox vaccine” [and died in 1823], and lots of thanking of various honourable friends.

Aside from the ceremonial thanking of all and sundry, the debate followed much the same themes as I’ve discussed previously. The trasncript is available here, and if there was ever any doubt on the impact meningitis infection can have, it contains many accounts of meningitis sufferers, and the effect it has had on their lives and the lives of their loved ones.

Here is my summary of the outcomes. Also check out my main Meningitis page for the complete story!

  • Many local MPs were in favour of extending the vaccination coverage, though noted they did not have the medical knowledge to judge whether this was the best approach. As stressed by Dr Whitford, MP for Central Ayrshire, “this is not a political decision; it must be made in the cold light of evidence “. They sought to represent their constituencies, and with at least one signee of the petition in every constituency and over 800,000 signatures in total, this was obviously high on the public agenda.
  • The important bit, from the under-secretary of state for health, Jane Ellison:
    • “Professor Pollard confirmed that a catch-up programme for one to four-year-olds would not be cost-effective at a realistic vaccine price. Also, the disease is so rare in those aged five to 11 that a programme for that age group would not be cost-effective, and the JCVI could not recommend it.”
  • The way we calculate cost-effectiveness for vaccines is being considered, generally. They are looking at “peace of mind”, discounting (currently any cost-benefit is discounted by 3.5% for each year of life, until it reaches zero!), and long-term social effects of a disease. The report should be available in the summer, and will be published. I’ll be keeping an eye out for that.
  • A study onto the effects of the vaccination in carriage in teenagers is underway. However, this will be a long-term study, with results not available for a few years. As teenagers carry the disease, not small children, if the vaccine is able to clear carriage in teenagers this may be the best way to protect the most people.
  • Public Health England are developing a public awareness campaign, focusing on symptoms. The effectiveness of the vaccine is currently not well defined, the vaccine does not cover all strains of meningitis B, and there are other types of meningitis as well. Hopefully this public awareness campaign will keep meningitis in the public eye. Please everyone, have a read on the Meningitis Now or Meningitis Research Foundation websites. Don’t wait for a rash.

Here are my final thoughts on the matter:

I agree with the MP for Central Ayrshire, decisions on what we vaccinate against, and what drugs are available on the NHS have to be done on the basis of available evidence. Our resources are limited, we can’t fund everything. The Joint Committee on Vaccination and Immunisation are independent. The government do not have the power to over-rule their decisions, and I think that is correct. Meningitis is a horrible disease, but thankfully rare. A balance needs to be found.

However, it would appear that some of the key information needed to define cost-effectiveness is not available or questionable. There are three key parts to working out whether we should be vaccinating all under 5s, or all under 11s against Meningitis B, but problems with the information in all three parts.

  1. What is the cost of the vaccine: We need a faster way of introducing novel vaccinations and drugs. While the Meningitis B vaccine was licenced in January 2013, it wasn’t available to the public until September 2015 because of time spent negotiating prices and ensuring cost-effectiveness. These processes clearly need improving.
  2. What is the cost of the disease: We know the disease is rare, but it does have large costs associated with it, in terms of long term disabilities, and societal costs. It’s clear the current methodology for pricing all vaccine-preventable diseases needs reviewing. Prevention is better than cure, and cost-effectiveness models should recognise that. Instead, “discounting” disproportionately affects preventative medicine – currently the cost of a disease is not measured over the whole of someone’s life because a discounting rate is applied. For a disease, such as meningitis, that usually occurs early in childhood and may have life-long costs associated with it, this is a problem.  As well as discounting, “Peace of mind” needs to be better quantified and the preference of protecting children acknowledged.
  3. How well does the vaccine perform: Because Meningitis B is so rare, we really don’t have enough information on vaccine performance. How effective is it? How long will immunity last? Without this information, the first of which will be available in September 2017, it is hard to work out the true value of the vaccination campaign and whether it should be extended to other age groups.

 

By the time we begin to get information on how well the meningitis B vaccination program is performing, those offered the vaccine at the beginning of the program will be turning two. By the time we have enough information to really inform cost-effectiveness, and hopefully a new cost-effectiveness model, those kids will probably be even older, and possibly their immunity will be waning. To protect a child until they are five, we may need a booster at additional cost, we just don’t know yet.

In the time taken to gather evidence, children too old for the vaccination campaign will catch Meningitis B, children will die, families will suffer. But, children will also die of other diseases. Other diseases that may also be worthy of money. In a system with finite resources, we can’t protect everyone from everything.

While I would love every child to be protected, the realist and scientist in me appreciates that we have to abide by the system. I truly hope that improvements are made to that system, that preventative medicine is prioritised and that introducing novel vaccines and drugs is expedited. I also hold high hopes in the teenage vaccination campaign – that may offer a real chance to eradicate Meningitis B.

 

 

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