Decisions regarding which vaccines the government fund are determined by cost-effectiveness analysis. For vaccines, this involves counting the cost of introducing a vaccine, versus the health benefits gained. Measuring such benefits is controversial, partly because assumptions are made about public preferences.
The team interviewed members of the public to determine how they think policy makers should prioritise vaccinations. They found a general consensusthat policy makers should prioritise vaccinations preventing severe disease in children as well as disease with high incidence, compared to those that fund milder infections.
Participants also agreed that decisions on determining whether a vaccine should be made available on the NHS should be based on a number of factors including, age, the impact on families caring long-term for a family member affected by a vaccine-preventable illness or disability, and social groups.
Participants indicated a preference for funding vaccination programmes that protect specific age groups considered to be most vulnerable to disease, particularly the very young and socially disadvantaged children who often have a lower underlying health status and should therefore be prioritised when targeting health benefits.
The findings indicate that the current approach may need to be refined when considering the benefit from childhood vaccinations.
Dr Gemma Lasseter, Senior Research Associate at the NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol said, “There is increasing debate about whether the QALY approach is appropriate for assessing the benefit from childhood vaccinations as vaccines against rare, but severe childhood illnesses such as meningitis and septicaemia, may struggle to get approved compared to those that prevent very common, but mild illnesses. In the future, this research could help ensure that policy decisions on vaccines consider real life public preferences and that vaccines are prioritised as the public want them to be - potentially shaping the future of vaccine availability.”
Vinny Smith, Chief Executive at MRF: said, “For a long time we have called for a reform of the cost effectiveness rules that put vaccines that prevent uncommon, severe childhood disease at a disadvantage.
“The MenB vaccine is one example of how flawed the system is. When the vaccine was first licensed, the UK government’s vaccine advisory committee did not recommend introducing the vaccine on the NHS based on cost. MRF fought hard to change this by submitting evidence highlighting the devastating burden of meningococcal meningitis and septicaemia on individuals and their families. Introducing the MenB vaccine for babies in 2015 was a major step forward, but offering vaccination for this age group alone will only prevent around a quarter of cases and if the vaccine rules had been fairer, more children could have been protected.
“Vaccination is the only way to prevent diseases like meningitis, and this study shows that the public value protection from severe disease, particularly for children. The rules that govern access to vaccines do not reflect the public’s preferences.”
Paper
The views of the general public on prioritising vaccination programmes against childhood diseases: A qualitative study' by Gemma Lasseter, Hareth Al-Janabi, Caroline L. Trotter, Fran E. Carroll and Hannah Christensen in PLOS ONE.