Unfunded vaccines can’t just be ignored, expert says

Nancy Notzon

writer

Nancy Notzon

Journalist

Nancy Notzon

 
It’s worth at least having a discussion with parents.

The return of this year’s Splendour in the Grass music festival after a two-year COVID-induced hiatus is probably not what organisers imagined.

Torrential weather in the lead up to the event in northern NSW caused chaos at the campgrounds, people were forced to sleep in their cars and now at least three people, including one child, have been diagnosed with the rare but serious meningococcal disease.

Most types of meningococcal disease, ACWY, are covered for the general population under the National Immunisation Program (NIP) and are free for patients.

“But, the most common form of meningococcal disease is meningococcal B, particularly in young infants under 12 months of age and for adolescents and young people between 15 to 25 years of age,” says Professor Peter Richmond, the head of paediatrics at the University of Western Australia, ahead of his lecture in an upcoming Healthed webcast.

Aboriginal and Torres Strait Islander infants and children under the age of two are at greater risk of the disease and are offered the B strain vaccine, MenB, under the NIP. Parents of non-Indigenous children are required to purchase the vaccine separately.

But just because an approved vaccine isn’t included in the general schedule, does that make it less important, and are parents being told enough to make informed decisions?

To make its way onto the NIP, a vaccine must first be assessed and registered as safe and effective by the Therapeutic Goods Administration. MenB has this tick of approval. But it must then pass another hurdle with the Pharmaceutical Benefits Advisory Committee (PBAC): will it be cost effective if used on a population basis?

For the meningococcal B vaccine, which needs three doses over a period to complete the course, the answer, so far, has been no.

“Generally, the PBAC have considered it and not felt that the evidence to date provides sufficient cost-effectiveness to make the vaccine implementable at the current price,” says Professor Richmond.

This leaves a gap in our coverage for a disease that can cause serious illness, permanent disability or potentially be fatal.

From January 1 to August 21 this year, 52 cases of meningococcal B have been reported to the National Notifiable Disease Surveillance System (NNDSS). In 2021, 35 cases were notified to the NNDSS.

In NSW, there were two deaths from meningococcal B reported in 2021, and one death reported in 2022 so far.

“Generally, my rough rule of thumb is that it’s pretty rare for a vaccine that’s recommended but not funded to be given to more than 10 percent of the eligible population,” says Professor Richmond.

A key contributor to this, says Professor Richmond, is that some parents are not aware of the disease, or believe its vaccine is covered under the current schedule.

“As a paediatrician, I see children who have got meningococcal B disease and almost always parents say, ‘I have never heard of it, I wish my GP told me about it.’”

Meningococcal B is not alone in this category. Two shots of the varicella vaccine to prevent chickenpox is recommended, but only one is covered under the NIP.

“One dose is enough to decrease hospitalisations, which is the biggest cost of the disease,” Professor Richmond says.

“What we’re starting to see now though is that we’re starting to get more varicella cases occurring, particularly in older children and teenagers – and it’s a very unpleasant disease.

“Their immunity has worn off after one dose, whereas if you’d had two doses you would still be protected.

“My argument for GPs is that unless you speak to families about this, about getting vaccines not on the schedule, but recommended by the national body ATAGI, how do you know what they would be prepared to do?”

Professor Peter Richmond is the head of paediatrics at the University of Western Australia, and a consultant paediatrician immunologist and paediatrician at Perth’s Children’s Hospital. He also is the head of the Vaccine Trials Groups at the Wesfarmers Centre of Vaccines and Infectious Diseases. He has no conflicts in relation to the topics covered in this story.

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Nancy Notzon

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Nancy Notzon

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