It is, they say, a matter of life and death. The to give the new meningitis B vaccine to all UK children has had more than 800,000 signatures – the highest number on record. On Tuesday parents of children affected by the disease gave evidence to MPs in the first of two sessions.
The vaccine was introduced for babies under 1 year old in September 2015, but the government says it isn’t cost-effective for older children.
Meningitis is one of the most feared childhood illnesses because of the way it can progress with terrifying speed to kill or maim those who were running around just the day before. The justification for withholding the shot is that meningitis B is rare, affecting only a few hundred children a year – so the benefits of vaccinating all children and teenagers look small next to most other things the NHS does.
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This decision looks right on the face of it. After all, the the Joint Committee on Vaccination and Immunisation, and when governments ignore their own scientists, they justifiably come under fire. But in this case, the petitioners may have a point.
Future health
There are several problems with the . One is that the extent to which the vaccine prevents disability was worked out using a scale designed for adults. It asks, for instance, if the person can dress without help or is depressed, questions that don’t easily translate to young children.
Secondly, the model gauged the vaccine’s costs and benefits using a system that some say fails to give due weight to future health. This is salient, as the benefits of a childhood vaccine may last a lifetime, unlike a cancer drug that extends life by months.
To be fair, the team used the standard system developed by the UK’s main body for assessing drugs, the National Institute for Health and Care Excellence (NICE). This is based on something called quality-adjusted life years, or “QALYs”. John Edmunds of the London School of Hygiene and Tropical Medicine, one of the study’s authors, agrees that the lack of weight given to future health is debatable. On the other hand, he says, it would be unfair to change the QALY rules for the meningitis vaccine, but not for the other things that NICE appraises.
Difficult trade off
But is it even valid to use QALYs to compare childhood vaccines with other things we do in healthcare? It can be argued that vaccines exist in a special category, given that they can prevent a child’s death – probably the worst thing that can happen to a family.
Claire Wright of the Meningitis Research Foundation has calculated that as judged by QALYs, stopping 5400 people from getting a short viral illness from which all recover is more worthwhile than stopping one 3-month-old dying. I personally wouldn’t accept that trade-off, and .
The government is saying that older children can’t have the vaccine “because of QALYs”. To accept that argument, we have to trust that QALYs are a valid tool. The example above suggests that perhaps we shouldn’t.
The petition has not yet been debated by MPs, but it’s hard to see how these complex arguments can be explored in the bear pit that is the House of Commons. One thing politicians are however good at is making pragmatic decisions based on expediency. For once, that might be just what the doctor ordered.
This article will appear in print under the headline “Putting a price on a child’s life”
