Meningitis B immunisation - eating my words
One of the most famous economists ever – John Maynard Keynes – apparently once said When my information changes, I alter my conclusions. What do you do, sir?" And I’ve been asking myself that a lot recently. Last week I wrote a blog about the terrible suffering caused by Men B, the strain of meningococcal bacteria that causes meningitis and blood poisoning. At the time, I said I supported the petition which by now has gained more than 800,000 signatures to extend immunisation against Men B to older children.
Since then, the facts haven’t changed but I’ve had a much more careful look at the maths – and while it’s likely to make me very unpopular to say so, the figures just don’t stack up. Before you close this page in disgust, bear with me – because I’m thinking about how we can best use our NHS’s money to help the most young people.
The number of people affected by Meningococcal disease varies year by year, but rates have been going down consistently for the last decade, halving across Europe from 1.92 per 100,000 people in 1999 to 0.92 per 100,000 in 2009. Some of that drop has been down to introduction of the Men C vaccine for all children in the UK – cases of Men C in the UK have dropped by 95% since routine immunisation, and Men C now accounts for only a tiny proportion of UK cases. In European countries which don’t have Men C immunisation, it’s the cause of about 1/3 of all cases of meningococcal disease.
But cases of Men B have also declined, from a peak of about 1700 cases in England and Wales in 2000-2001, to 800 in 2009-10, to 600 in 2011-2 . Sue Davie, chief executive of the Meningitis Now charity, has said that “In 2014/15 there were 101 cases of the diseases in under 1s, and 139 cases in the age range 1-4.” Of course the numbers vary from year to year, but there has definitely been a consistent downward trend.
About 2/3 of people affected by Men B are under 5, with the majority of these under 1 and a peak at 5-6 months of age. There’s a very small second peak in 15-19 year olds, but this accounts for under 4% of cases. The vaccine was introduced in September 2015, with immunisations at 2, 4 and 12 months. There has also been a limited catch-up immunisation for babies born between June and August 2015. That means all under 8 month olds are already covered, if they took up the offer of free immunisation on the NHS.
Some of the people petitioning for wider immunisation want all under 5s covered – others want the immunisation to extend to everyone under 11. Children over 6 months need 2 injections to protect them (under 6 month olds need 3)
The NHS list price of Bexsero, the Men B immunisation, is £75 – that’s £150 per child over 6 months protected. The government has negotiated a huge discount for the NHS immunisation programme, with a single immunisation costing £20 - £40 for every older child immunised. But that’s just the cost of the injection itself – It probably costs another £20 per child at least to employ health care professionals to give these immunisations
All these variables make it impossible to calculate the cost of a wider immunisation programme, but I’ve used some averages which give a good idea of the overall costs involved. I’ve used the figures for England and Wales rather than the whole of the UK – not because I’m ignoring our Scottish and Northern Irish friends but because most of the official figures are for England and Wales. Here’s the maths:
- 700,000 children a year born in England and Wales
- 4 ½ years’ worth of children need immunising if we’re going to immunise the under 5s who aren’t covered
- That’s a total of 3.15 million children
- Immunising each child is likely to cost at least £60
Total cost for immunising all under 5s in England and Wales against Men B - £189 million
If we were to include all under 11s, the equivalent cost would be £441 million.
We also need to bear in mind that one pair of immunisations may not be enough. Immunity from most vaccines wanes over time, and the manufacturers’ own studies have shown that ‘Trials which have measured the response rate in infants 8 months after immunisation with Bexsero have shown some reduction in response. This reduction is consistent with current scientific expectations.’. Would we need to give all children a booster every year? We don’t know yet, but if we did, that would add up another £90-£220 million to the bill.
I know children stricken with Men B are all too often left with dreadful disabilities even if they survive – and this has a financial as well as a human costs. But others are suffering too. The repeated raids by the Government on funding for CAMHS (child and adolescent mental health services) is a disgrace, and the total NHS budget for all the services to treat the millions of under 18s who suffer from mental health problems was £704 million last year. Immunising all under 11s against Men B just once would take up well over half the annual budget for young people’s mental health.
The sad fact is, there isn’t a bottomless pit of money in the NHS and difficult decisions have to be made. While I’m delighted that we can offer all new babies protection against the horror of Men B, we can’t always let our hearts rule our heads. If we do, the price other vulnerable groups would pay might make for even more tragic reading