Currently, the meningitis B jab is routinely given only to infants, but British parents are demanding the vaccine for all children under the age of eleven. Is that realistic or cost-effective? Two Oxford professors offer their answers.
By Olivia Gordon
Two Oxford University scientists at the forefront of research on the meningitis B vaccine have shared their expert opinions with Oxford Today.
The vaccine has become the subject of national debate after social media publicised the tragic story of two-year-old Faye Burdett who died in February from meningitis B. The meningitis B vaccine, licensed in 2013, was introduced on the NHS for babies a year ago. But it’s only available privately for children born before 1 May 2015, and is currently out of stock nationwide, which has led to inflated prices charged for remaining doses and panic on online parenting forums. A petition signed by more than 800,000 people demanded the NHS roll out the vaccine to all children but the government has so far rejected the idea.
Andrew Pollard, Professor of Paediatric Infection and Immunity at the University of Oxford, is Chair of the Joint Committee on Vaccination and Immunisation (JCVI), the body which, in 2014, advised the NHS not to give the vaccine to all children. ‘It’s the most absolutely devastating disease,’ Pollard says, and ‘the committee would like to have been in a position to be able to prevent every case’.
Unfortunately, it’s not that simple, because of NICE rules on cost effectiveness, which bind the decision made by the JCVI. Despite its high profile, Pollard explains, meningitis B is in fact a rare disease on the decrease and ‘in the last few years we’ve had an exceptionally low number of cases’. The cost-effectiveness rules ensure that the NHS budget is used to maximise quality of life across the population, ‘so that funds are not focused on one rare disease when there would be greater benefit improving quality of life elsewhere’. And so, says Pollard, ‘we were limited in the scope of the programme that could be recommended.’
Pollard says: ‘By five years of age, the risk of meningitis B is very low and it’s difficult to justify vaccinating a child, but in the first few years of life there is a much greater risk, with the highest rates being in those under one year of age. That’s why the most cost-effective approach is to vaccinate those with the highest chance of getting the disease, the under-ones. We’re giving advice within NICE rules on cost effectiveness - from that perspective it does make sense for the NHS [to vaccinate only babies], but of course it’s a different perspective if you’re a parent.’
He adds that ‘the rules may seem, in a sense, a bit arbitrary, but they are about ensuring equity in the health system’. In 2014 the JCVI advised the Department of Health to consider revising the cost-effectiveness rules for vaccines which defend public health. Pollard says: ‘A report is expected sometime this year which will advise whether there should be any changes. We don’t know what it will say yet, and it could be that the outcome is that some vaccines may be less cost-effective, or alternatively that [vaccination] programmes could be expanded if a revised approach was more favourable.’
Christoph Tang, Professor of Cellular Pathology at the University’s Sir William Dunn School, is part of one of the world’s leading teams researching meningitis. He explains that, in contrast to straightforward vaccines for meningitis A, C, W and Y, the meningitis B vaccine is ‘a complex, imperfect vaccine and much harder to make’ (even if the government wanted to vaccinate everyone, they couldn’t, because it’s so difficult to make, and therefore in short supply).
Meningitis B is a diverse organism and the vaccine doesn’t cover all its strains. Furthermore, Tang says, ‘we don’t know how long [the vaccine] lasts – it could be a couple of years or less. So just because you’re vaccinated doesn’t mean you’re protected’. Still, he says, parental fears about meningitis B are justified: ‘nothing changes a well child into a sick, even dead, child so fast.’
There is hope on the horizon: Tang and colleagues are working on ideas for a better meningitis B vaccine and are creating a DNA library to help decipher all strains of meningitis, as well as trying to understand why some people get ill and others don’t – many people carry meningitis B but are unaffected, while others seem to have a poorer immune response to it.
Pollard says vaccinating teenagers might be the best programme. ‘Teenagers seem to be the reservoir of the meningitis B organism, as they carry the bacteria in their throat at high rates. If we could stop them carrying it, there would be a reduction in transmission across the population, and all of us would be protected.’
In September, he adds, we will have the first evaluation of the current NHS meningitis B vaccination schedule for babies. ‘If it has the impact the models have predicted of preventing 60-90% of the disease, we could see a substantial reduction in cases of this awful disease in our population.’
Images: Oxford University Images