Questions and discussion about the costs involved in rolling out the Meningitis B vaccine

[Myredcardigan]

Partly a TAAT but obviously it's all over the news and Sugar has specifically asked me to start this thread to begin constructive debate.

So, from my pov, I totally get the massive cost implications of vaccinating all those under 11. However, id like to hear from anyone who is in the know and can tell me if link to data showing what the actual cost would be. I'd also like to see what the cost implications of treating children with the disease are. Both the acute care, which will cover all infected children, but also the long term costs both medically and educationally of treating those children lucky enough to survive but sadly left with life long disabilities. I know from an educational POV that a non mainstream state school place can cost 40% more. Sometimes much more. But I have no idea on the medical side. Questions such as,

-How much does it cost the NHS in acute care costs to treat a child with Men B for 1wk

-What about non acute NHS recovery support inc OT

-If you are the parent of a deaf child or are deaf yourself, can you comment on the cost implications of supporting your child (rightfully) both medically and educationally?

-Can anyone comment on the NHS and educational costs involved in supporting a child who is an amputee?

Any other relevant stats and info please add to the thread. Please remember that Sugar has asked for this thread to be put out there. Of course, from a personal perspective I don't think any of this should matter but should the petition get its debate then this is what they'll be looking at.

This is really interesting.

www.theguardian.com/science/occams-corner/2015/sep/01/why-is-the-nhs-vaccination-for-meningitis-b-not-provided-to-everyone

A good compromise situation for the Government at this stage would be -

• A catch up vaccination for ages five and under (they have already done the babies)
• Whist doing this catch up, negotiate price down with the manufacturer (as Steve Dayman suggested in interview).
• Hopefully as soon as possible widen it out to the next at risk groups children & teens (15-20 years) as & when new drugs, knowledge about the longevity and price improves. Anyone like me who is worried in the meantime pays privately as under 5's are priority.

Not perfect for either side but progress.

Motherbug. You may find this interesting if you haven't read it already. It is quite long though. Re immunogenicity it says:

"The persistence of these immune responses was examined in a small follow-up study (NCT01027351) at 40 months of age following vaccination of infants and toddlers at 2, 4, 6, and 12 months [25]. At 40 months of age, 41–76 % of the 17 children tested still maintained protective bactericidal antibody titers (titer ≥4) to each of the four vaccine components following 4CMenB (fHbp, 65 %; NadA, 76 %; NZ OMV, 41 %; NHBA, 67 %). "

So the vaccine lasts quite well then.

Thank you. That is interesting. So protection may not be as short lived as I'd feared based on the manufacturers info. However, based on those 17 cases, I'd say it's pretty likely there'll need to be boosters to get immunity till age 5. As mentioned above, we do already do a whole host of boosters, so it's possible obviously, but does increase cost. If faced with a choice, I'd say vaccinating under 5s, then any boosters required to get those already vaccinated until age 5 should be a priority. I'm still not sure the JCVI will do anything without more evidence, however (not saying that is necessarily the right approach, just how they work).

Bumbley, that reference quoted in the excerpt above is shorter, and an interesting read:

www.ncbi.nlm.nih.gov/pmc/articles/PMC3890039/

Looks good to me having read that report. They would need to prioritise under 5's first anyway (because of sheer logistics) so that would give time for price negotiation for the drugs.

Can they really ignore 750000 people? What is the point of having online petitions if they are just ignored? I notice they have rapidly released a new health story today.

Good point about lots of other vaccines needing boosters.

The JCVI need to factor in the huge cost of looking after children damaged by Men B into their cost benefit analysis. A bit like the fitting of gastric bands - the argument is if you pay to fit them it reduces obesity and the strain / cost on the NHS lessens.

Sugar every parent's nightmare. Peace be with you, be strong.

I am reading this thread with great interest. So many knowledgeable people here.

How are people infected with (bacterial) Meng?

What does the latest research say, is there funding for Meng research?

Why is there no antidote?

Why is this such a 'creeping' disease, i.e. every parent is afraid of it but we know so little about it. I like facts, what are the facts?

I can't imagine they'll ignore it. I hope they do some further costings and research following this. I'm a bit disappointed they haven't come or with an interim statement.. The cogs of government move so slowly, and I think in the age of the Internet this isn't really acceptable the public.

This is off the Men Research Foundation website -

The risk of getting the disease is very low. Although meningococcal disease is infectious and can cause outbreaks, 97 out of every 100 cases are isolated, with no link to any other cases.

The bacteria that cause the disease are very common: at any time about one in ten of us has them in our noses and throats without ever knowing they are there, and for most of us this is harmless. We pass the bacteria between each other by close contact (e.g. coughing, sneezing, kissing).

Usually we have to be in very close or regular contact with someone for the bacteria to pass between us. Even when this happens, most of us will not become ill because we have natural immunity.

The bacteria cannot live longer than a few moments outside the human body, so they are not carried on things like clothes and bedding, toys or dishes.

and I believe this is the way research is funded.....

www.meningitisnow.org/how-we-help/research/spencer-dayman-research-fund/

Thank you 1234

"Usually we have to be in very close or regular contact with someone for the bacteria to pass between us. Even when this happens, most of us will not become ill because we have natural immunity."

Is there any evidence or at least some insight on what causes the body to fall ill with the virus / bacteria if we carry it around? thanks.

sorry, not very well formulated. What I mean is is there any knowledge about what potential factors make it riskier and more likely to fall very ill with Meng?

There seems to be the idea that those who fall ill with Men have a lower natural immunity. But it is very rare.

www.nhs.uk/Conditions/Meningitis/Pages/Causes.aspx

motherbug that link you posted upthread just linked to the same, longer paper that I posted. Do you have the link to the shorter one you mentioned?

Yes, the protection quoted in that paper is a bit longer than what the manufacturers stated. Perhaps because it was such a small sample they were being cautious? Or maybe they have a threshold that they consider acceptable and it wanes to that after ~18 months? 41% isn't great so I would imagine they would want it up closer to the 76% mark.

Try this one: www.ncbi.nlm.nih.gov/pmc/articles/PMC3796620/

It seems the current vaccine protects against some strains better than others. It's a complicated vaccine because of the nature of men B - surface proteins are very poorly immunogenic. That makes it pretty hard to evaluate. Even overall efficacy is not well documented. In part, it's going to depend whether it reduces the nasal carriage of the bacteria, which I believe is still under investigation, and whether it has an impact on terms of herd immunity. Herd immunity will only really workif, as well as protecting against meningitis it reduces carriage too.

I would be really grateful if everyone would read this....(from 2014 when approval was being sought for the Men B vaccine for babies) It makes some interesting points about the way the cost benefit analysis is undertaken.

www.dailymail.co.uk/health/article-2538991/Meningitis-B-jab-green-light-Doctors-call-Health-Secretary-authorise-vaccine-protects-children.html

We have no qualms about administering expensive treatments such as surgery and chemotherapy to some very sick cancer patients who will see only a minor extension of their life span at best’ said Professor John Mekalanos, of Harvard Medical School, Boston in the US.
He said, in an article in Science Translational Medicine, the jab was being blocked by ‘hypothetical financial concerns of cost-effectiveness

Parliament will discuss reversing a controversial decision to limit the meningitis B vaccine to babies under nine months after MPs acknowledged that a record-breaking online petition had to be "taken seriously".

www.telegraph.co.uk/news/health/12168764/MPs-to-debate-meningitis-B-vaccine-within-weeks.html

That's fantastic news, I'm glad it's being debate. I hope a similar thing will also happen with group B strep, a leading, but preventable, cause of meningitis in newborns.

Have done interview will tell later Im a wreck atm

Latest Update

It isn't considered cost effective.

www.meningitisnow.org/support-us/news-centre/news-stories/petitions-committee-starts-debate-process/