Posted on 10/26/2004 11:48:57 PM PDT by neverdem
A committee of experts meeting in Atlanta will debate today whether the government can afford to pay for a vaccine that could save the lives of nearly 3,000 people, many of them teenagers, from deaths caused over the next decade by a virulent bacterial meningitis.
The price of the new vaccine will most likely be $80 a dose. Vaccinating all 40 million people from age 11 to 20, as some experts have suggested, would cost the government $3.5 billion next year. That is more than $1 million a life spared, far more than health officials are normally willing to spend.
"How much would we have been willing to spend to save the victims of the 9/11 attacks, because that's the number of people we're talking about?" asked Dr. Paul A. Offit, the chief of infectious diseases at Children's Hospital of Philadelphia who is a committee member. "I believe it's money well spent."
Dr. Jon S. Abramson, chairman of the pediatrics department at Wake Forest University Medical School and another committee member, said the government could not afford such a campaign.
The debate before the Advisory Committee on Immunization Practices is a classic argument about how much the government should spend on breakthrough technologies that spare life and prevent suffering. Medicare officials frequently struggle with similar debates as they decide whether to pay for expensive wonders like implantable defibrillators or brain scans.
These debates were once unheard of among vaccine experts, because most inoculations are far cheaper than the cost of treating the diseases they prevent. As a result, the government buys and distributes more than half of all vaccines.
That system is under strain. The latest vaccines are expensive, and the diseases they affect are increasingly rare. For the first time, the government has to decide whether such medicines are worth the cost.
Regardless of the panel's decision, people who can afford the new vaccines will quite likely have access to them. Families relying on Medicaid and other government programs, however, may not obtain the vaccines.
Most parents of college students are sent letters by the colleges that suggest that their children be vaccinated against bacterial meningitis. Menomune, the vaccine currently sold to fight meningococcal meningitis, provides protection only for a few years, and it is minimally effective in young children. The new vaccine, Menactra, will be the first to provide long-lasting immunity.
The debate occurs amid a flu vaccine shortage that has become one of the worst vaccine-related crises in decades. The advisory committee, the government's chief panel of vaccine experts, is scheduled to spend this morning to discuss the flu crisis. The afternoon will be devoted to Menactra, manufactured by Aventis Pasteur to prevent meningococcal meningitis, a disease that can kill healthy teenagers within hours.
The committee will make a recommendation to the Centers for Disease Control and Prevention, which will follow its advice after Menactra has been licensed for sale by the Food and Drug Administration, which is widely expected to occur soon.
Besides deciding whether to pay for Menactra, the committee also has to figure out how to have children take the vaccine.
"We don't have a good track record immunizing adolescents," said Dr. Lance Rodewald, director of the immunization services division of the National Immunization Program at the disease centers.
Solving this riddle is crucial, because Menactra is generally expected to be the first of a series of new vaccines intended for 11-year-olds. The others include booster vaccines against tetanus, diphtheria and whooping cough and vaccines against cervical cancer and herpes.
Frightening parents about the consequences of failing to vaccinate their children will most likely be part of the campaign. For that task, meningococcal meningitis is ideal.
"The disease is truly awful," Dr. Rodewald said.
Kathy Huddleston, 59, of Cedar Rapids, Iowa, had never heard of the disease until last September, when she learned that her 20-year-old daughter, Elizabeth, was dead at a hospital in Cedar Falls, Iowa. Elizabeth, a junior at the University of Northern Iowa, awoke with what she thought was the flu on Sept. 21. Elizabeth took a shower around midafternoon and noticed a rash, Ms. Huddleston said. Around suppertime, she began throwing up.
Her boyfriend took her to an emergency room, where doctors diagnosed the flu and sent her home. At 5:30 the next morning, she started having trouble breathing. She died before her boyfriend could return her to the hospital.
The case is typical. By the time victims realize they are desperately ill, it is often too late. Fever, nausea and flulike symptoms are often followed by a rash, stiff neck, sensitivity to light and delirium. Infections can be fatal within hours, although quick and aggressive use of antibiotics cure most infections without permanent effects.
"It's one of the few remaining infectious diseases in America where someone is healthy one day and dead the next," said Dr. Nancy Rosenstein of the meningitis and special pathogens branch at the disease centers.
Meningococcal meningitis is one of three forms of meningitis caused by ball-shape bacteria with slimy coats that are particularly tough for the body's immune system to fight. Illness caused by the other bacteria like haemophilus influenza type B and pneumococcus were once far more common, but there are effective vaccines against the two.
The bacteria that cause meningococcal meningitis commonly live in the human throat and nose. Why they sometimes invade the spinal fluid or bloodstream is not understood.
Nearly 3,000 Americans a year are sickened. About 300 die, and 600 are permanently scarred or disabled.
Whether Aventis could make enough vaccine for all teenagers is in doubt, said Dr. Michael Decker, the company's vice president of scientific and medical affairs.
Lynn Bozof of Marietta, Ga., said she would spend any amount to get back her son Evan. Evan, a 20-year-old junior at Georgia Southwestern University in Americus, died of meningitis after he began having what he thought was a migraine.
"The government needs to find a way to pay for this and protect all of our children," Ms. Bozof said.
FReepmail me if you want on or off my health and science ping list.
At some point people need to realize that we have limited resources and need to prioritize spending...
What's that, pizza, a movie and a couple of cd's or maybe a piercing or a pair of sneaks or it could be a few months of cell phone fees.
"The government needs taxpayers need to find a way to pay for this and protect all of our children," Ms. Bozof said.
Yeah right.
bump and thanks!
This is so overrated. There is enough to cover the old and the very young, most of the rest can go through several flues without that much trouble. Christ, 100 years ago it wasn't the flu that had large wipe outs of population. True more died but somehow humanity kept growing.
Crazy idea: bracket it: for those with incomes above 40K no subsidy. For those with incomes 30-40K, 30% subsidy, 20-30K, 50% subsidy, below 20K free. That would save the goverment most of its money...er OUR money.
The problem with that is the free rider effect. People don't pay for the vacine counting that others around them are vacinated and they don't need to be. Well this quickly escalates into a critical mass, where the needed percentage of vacinated to prevent a major outbreak is not there: thus a major outbreak or plague. Sure afterwards people will remember for a generation or two, but the costs of those outbreaks are usually much higher then the cost of the vast majority of immunizations.
>>At some point people need to realize that we have limited resources and need to prioritize spending...
That's a really fundamental issue. Unfortunately, we tend to have political decision-making based on emotion and headlines, rather than hard-headed rationality.
Worth the cost to whom?
Anybody can afford $80 for heroin, or cigarettes, or booze.
therefore, everyone can afford this vaccine, if they want it.
What nobody can afford is healthcare that's "free".
Both of my sons got meningococcal vaccine before they went off to college.
Anyone who can afford college can afford meningococcal vaccine.
Ms. Bozof, I'm sorry for your loss, but why were you so cheap as to not pay for this yourself?
The reason we have a shortage of flu vaccine this year is due to meddling by the Federal government and trial lawyers. Great idea. Let's get the Federal government involved with this vaccine, too, and then nobody will be able to get it, either. You would think people would learn after a while.
I run a clinic that offers pretravel vaccines.
You know, yellow fever, meningitis, etc.
Insurance doesn't pay for these vaccines, for the most part.
You would be amazed at the number of people who, having spent $10,000 plus on a trip to some dangerous locale, walk out when they find out the vaccine isn't free.
Why should it cost the government anything?
They have done so for many years.
Links:
http://www.emedicine.com/NEURO/topic210.htm
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/meningococcal_g.htm
The DoD probably gives Menamune; neverdem probably means Menactra, the new meningitis vaccine, which is more effective.
It is very disturbing that a CDC recommendation about whether or not people should get this vaccine (or any other vaccine) has now become contingent on whether or not the governemnt can pay for the vaccine.
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