News

MPs demand to know why government restricted meningitis B vaccine to infants under 1

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5563 (Published 30 November 2017) Cite this as: BMJ 2017;359:j5563

Re: MPs demand to know why government restricted meningitis B vaccine to infants under 1

The Petition and Health Committees have declared that the government’s response to the meningococcal B (MenB) petition – the largest ever UK petition on health – is unsatisfactory. They are particularly concerned that the government’s promise to publish a report about reforming the rules that govern vaccine decision-making has not been kept. Meningitis Research Foundation (MRF) is pleased to see both committees demanding the publication of the Cost Effectiveness Methodology for Immunisation Programmes and Procurement (CEMIPP) report and wider consultation on the government’s response to this[1].

The report has the potential to determine which vaccines will be included in the national immunisation programme in the future. Transparency and wider consultation with public health experts and health professionals is essential when so much is at stake.

The CEMIPP working group was set up in 2014 at the request of the Joint Committee for Vaccination and Immunisation (JCVI) because the Committee expressed concerns that the current methods for assessing the cost effectiveness of vaccines undervalue the impact of preventing uncommon, severe disease in childhood[2].

MRF has consistently highlighted the way in which the existing cost effectiveness framework, which is the same framework NICE uses[3] unfairly undervalues vaccines, in particular those which prevent severe childhood illnesses like meningitis:

• The application of unfairly high discount rates to the health benefits of vaccines (at 3.5%) disadvantages childhood vaccines because much greater importance is placed on short term health gains compared to those which impact far into the future
• The EQ-5D, which is the tool recommended to measure the health impact of diseases, cannot accurately measure health impact in young children
• The public’s preference for prioritising prevention, severity of illness and health gains in children is not well reflected in the rules

The spotlight fell on some of these issues during the deliberations over the introduction of the MenB vaccine, which was introduced for infants without a wider catch up for older children, as this was not considered to be cost effective.

Following the tragic death of 2-year-old Faye Burdett the MenB petition sparked a parliamentary debate about wider vaccine use. This led to questions about CEMIPP’s conclusions, since a reform of the cost effectiveness rules specifically regarding discounting would have made a catch up campaign for some older age groups cost effective[3].

Responding to the debate, the government promised that the CEMIPP report would be published before the end of 2016. This did not take place. Instead the CEMIPP report was subsumed into the government’s Appraisal Alignment Working Group (AAWG).

2017 is now drawing to a close, yet we are still waiting for publication of this report which could have huge ramifications for all vaccines.

Vaccine decision making needs to be fair and vaccines need to be recognised for the true value they provide. MRF has serious concerns about the process so far, and is pleased to see the Petition and Health Committees supporting our call for an open and transparent consultation on the cost effectiveness framework. NICE follow clear consultation processes in the context of therapeutics. Vaccines, one of the most effective health interventions in the world, deserve this too.

1. Petitions and Health Committees urge action on CEMIPP report (meningitis B). 2017 [cited 2017 4th December]; Available from: http://www.parliament.uk/business/committees/committees-a-z/commons-sele....
2. Joint Committe on Vaccination and Immunisation. Minute of the meeting on Wednesday 2 October 2013. Available from: https://app.box.com/s/iddfb4ppwkmtjusir2tc/1/2199012147/18992166933/1.
3. Christensen, H. and C.L. Trotter, Modelling the cost-effectiveness of catch-up 'MenB' (Bexsero) vaccination in England. Vaccine, 2017. 35(2): p. 208-211.

Competing interests: No competing interests

07 December 2017
Claire L Wright
Evidence and Policy Manager - Prevention
Linda Glennie, Rob Dawson, Vinny Smith
Meningitis Research Foundation
Newminster House, Baldwin Street, Bristol