The death of two-year-old Faye Burdett from Meningitis B in 2016 sparked the UK’s biggest ever health-related petition to government. More than 820,000 people asked to widen the hard-won vaccination programme against this rare but devastating disease. But now, other vaccination programmes are under threat as the government considers changing its funding rules.
It took the petition and a debate in parliament for the Department of Health and Social Care (DHSC) to finally agree to publish an existing report. The department commissioned the report on the cost effectiveness of vaccination in 2014. The appointed committee completed it in 2016. This week, it has finally surfaced. The delay didn’t stop parliamentary under secretary Steve Brine MP from boasting. He said he had delivered on his promise to hold a consultation. Of course, technically, someone else made that promise while Brine was still a backbencher.
The CEMIPP vaccine report has been published and the consultation launched just as I promised. We will carefully consider the responses before making any decisions. #sayyesminister https://t.co/Fmq2YFAmul
— Steve Brine MP (@BrineMinister) February 26, 2018
The government’s petitions committee questioned Brine on 27 February. Why? Because the committee wanted to know why the department failed to publish the report for two years.
Chair of the petitions committee Helen Jones MP said:
It was clear from the evidence that we heard in 2016 that there are serious questions to answer about the way the Government decides which vaccines are cost-effective. The Government itself recognises this – it set up its own Working Group to investigate. But that report was produced 18 months ago and it still hasn’t seen the light of day.
These may sound like technical issues, but they’re key to decisions that could save children’s lives. The Committee will want to find out from the Minister why the Government is dragging its feet on something so important.
Vinny Smith, chief executive of the Meningitis Research Foundation, heard the evidence. He told The Canary that:
if implemented as a package, the report recommendations would result in the opposite of what the petitioners wanted. The 820,000 people who signed the petition wanted wider access to vaccines, but the recommendations in the report would make it much harder to get vaccines introduced.
The minister said his door is always open and he wants to engage with the public. But the DHSC admits the consultation is “primarily aimed at specialists with an interest in health economics”. Mixed messages?
Many more treatments could fall into the ‘too expensive’ category because the government wants to cut the funding threshold by 25%.
The maths behind all of this is complex. Essentially, for every year of quality life regained – a statistical unit called a QALY – there should be a cost of no more than £20,000. But the report says that, for vaccination programmes, the threshold should drop to £15,000. This will threaten some programmes. Those aimed at preventing rare but very serious illnesses, including Meningitis B, face particular risk.
The report also suggests that all cost effectiveness calculations in healthcare use the threshold of £15,000 per QALY. This could potentially pressure the National Institute for Health and Care Excellence (NICE) to change the way it decides on the cost effectiveness of many drugs, devices and technologies.
The DHSC’s Appraisal Alignment Working Group (AAWG) is responsible for making sure all areas of healthcare calculate cost effectiveness in the same way. The AAWG has cautiously given its stamp of approval. It seems likely that NICE will be told to get in line. Many forms of preventative medicine would be at risk if that happens.
A NICE spokesperson told The Canary:
We are aware of the consultation, which has no direct impact on NICE’s cost effectiveness threshold.
But when will I be well, doctor?
Vaccines are given to healthy people, and it is impossible to say when they deliver their benefits. This makes vaccination programmes difficult to analyse. In the past, health economists have tried to address this by adding an extra step to the calculation for vaccinations. It’s a kind of weighting that accounts for the uncertainty around long-term benefits. But health research charities argue that the weighting given to vaccination programmes is too great and underplays the benefits.
The Meningitis Research Foundation told The Canary that a baby vaccinated against Meningitis B could have 80+ years of health thanks to that vaccination. But with the current weighting, only 27.7 years count in cost effectiveness calculations.
In a win for the charities, the report does suggest reducing the weighting. But another recommendation has the potential to undo this.
The report suggests choosing a ‘time horizon’, which is a cut-off point beyond which it is too difficult to estimate future benefits. It’s unclear how this would work in practice. Vaccination programmes would be assessed as if the benefits are infinite, but with a caveat – the time horizon. Cost effectiveness could be calculated over 50 years, or 25 years, or any other time period.
If the AAWG insists that all preventative medicine be assessed in this way, lifesaving early interventions could become effectively unfundable.
Most people want medicine to prevent illness, especially to guard against rare and serious diseases. The report has not taken this into consideration at all.
Now is the time to speak out against the destruction of healthcare that prevents illness and disease, and promotes wellness.
The Canary contacted the DHSC for comment but none was forthcoming.
– Respond to the consultation (online survey).
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