UK vaccines body under scrutiny over Men B jab restrictions


The UK's deliberations on cost-effectiveness of vaccines have came under scrutiny, as members of parliament probed the controversy around GlaxoSmithKline's Bexsero meningitis B jab.

MPs quizzed experts from the Joint Committee on Vaccination and Immunisation (JCVI) who recommended that only infants should receive the vaccine, ruling it to be only cost effective in this high risk group, and heard calls from charities who want broader coverage.

Politicians from the Health Committee and Petitions Committee held the evidence session after more than 800,000 people signed a petition calling for all children to be covered by the vaccination programme. Because of the support for the petition, there will be a parliamentary debate on the meningitis B jab.

Vinny Smith, chief executive of the Meningitis Research Foundation, said the JCVI's cost effectiveness model failed to take into account long-term benefits to patients whose limbs or lives could be saved, calling for changes to its discounting model to better reflect benefits over a lifetime.

He told MPs at the meeting in Westminster that the JCVI's modelling failed to take into account the "peace of mind benefit" felt by parents whose children could be saved from catching the disease.

Smith said: "This is the benefit every parent is feeling – it is something that they would put a value on if they could."

"It does not express the public preference for treating children over adults," he added.

The MPs heard that the JCVI uses a discount rate of 3.5%, which is the standard rate recommended by the Treasury and is used across the whole public sector. Smith said this rate should be lowered to around 1%, which would better reflect the long term benefits of vaccination, adding that the JCVI must publish ongoing work on potential changes to its cost-effectiveness model.

Professor John Cairns, professor of health economics at the London School of Hygiene and Tropical Medicine, said he had chaired a working group investigating whether JCVI's cost-effectiveness calculations should be different from those used by NICE.

His findings will be presented a report to the Department of Health in the coming weeks – although it is up to the DH to decide whether to publish its findings.

Cairns said: "We have identified some areas in which we can make an argument that immunisation is somewhat different. We are moving in the direction that most of the methodologies used for other health technologies are appropriate for vaccination."

Under further questioning, Cairns said that "the discount rate is a major item for consideration."

He added: "We have had extensive discussions about peace of mind, that will certainly be part of our report."

However he said it was inappropriate for cost-effectiveness decisions on vaccines, or any health technology, to be made on the basis of a formula, saying there must be "deliberation".

Professor Simon Kroll, professor of paediatrics at Imperial College, London, spoke in favour of a wider vaccination programme including adolescents, who are more likely to be disease carriers.

Kroll backed the Smith's comments on the long term benefits of vaccination. "It is a one-off cost, but it is one that I think will have a substantial impact."

He added that GSK's Bexsero had been "enthusiastically taken up" by families, with response rates of 95% for the first jab and in "the eighties" for the second jab.

The lower uptake of the second jab is likely because the vaccination programme is new, said Kroll.

Professor Simon Nadel, consultant in paediatric intensive care at St Mary's and Imperial College, London, said that costs such as divorce, caused by the pressure that the disease can place on families, are "often underestimated."

22 March, 2016