The Health Council wrongly advises against vaccination against meningococcal B. The government should actually include that vaccine in the vaccination program, write Groningen professors and health economists Maarten Postma and Cornelis Boersma.
The Netherlands has long been known as a pioneer in the field of innovative vaccination policy. But that has changed dramatically over the years. Nowadays we accept increased health risks. We illustrate this with a recent example.
“Meningococcal B is a very serious disease that can lead to meningitis and blood poisoning and can be fatal. That is reason to consider vaccinating children and adolescents against this disease via the National Immunization Program (RVP)”. The Health Council writes this in a recently issued advisory report.
That sounds hopeful. Meningococcal B is indeed life-threatening, especially for small children. But anyone who studies the Council’s advice further will be disappointed: the cost-effectiveness of the vaccination is ‘… very unfavourable, because the number of cases is low, the price of the vaccine is high and multiple doses are required’. Final verdict: Secretary of State, do not include the vaccine in the NIP.
A missed opportunity. We do not understand the Health Council’s reasoning about the assumed unfavorable cost-effectiveness. After all, it is generally known that vaccine prices in a large-scale vaccination program are much lower than the individual official list price. And yes, the number of cases is low right now, but just insisting on that is a short-term view. Meningococcal B is a fluctuating disease and the number of cases will rise again, as we saw with meningococcal C around the turn of the century. Vaccination against meningococcal B is therefore an investment in the health of future generations. In this way we can save the lives of children and prevent complications in their later life.
Let’s look at England. This is now leading the way with a more innovative vaccination policy. We can also take an example from that country when it comes to meningococci B. England started a targeted meningococcal B vaccination program as early as 2015. Children who receive three doses of the vaccine appear to be no less than 62 percent less likely to become ill.
Penny wise, pound foolish
There is therefore no doubt that the vaccine is effective. Also, the vaccine could become cost-effective if we consider the possible increases in the number of cases and realistic pricing. The costs do not only concern the direct consequences of the disease, but also indirect social costs, such as special education, long-term care and loss of parental productivity. The vaccination against meningococci B then falls well below the generally accepted standard of 80,000 euros for saving a quality-adjusted life year as used in the event of serious illness.
Despite all the wisdom of the Health Council, we would do well to introduce vaccination against meningococcal B anyway, and thus complete the protection against meningococcal diseases. After all, vaccination against the other types – A, C, W and Y – has been going on for several years.
With the knowledge that various new or innovative vaccines are on the way, our call is: government, implement an innovative vaccination policy that does not penny wise, pound foolish is. The Netherlands spends approximately 0.014 percent of its gross domestic product on vaccinations. That amounts to 6 euros per Dutch person. That is little compared to other countries. Take Germany, for example, which spends 16 euros per inhabitant on this. The costs of the national vaccination program (100 million euros per year) are relatively very limited: just over 1 percent of the total healthcare budget. With a small investment, the Netherlands will once again be at the forefront of European vaccination. The result: a healthier population. We owe that to our position.
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