A Pox on the Taxpayer

 

A handful of countries recommend the chickenpox (varicella) vaccine for all children and an even smaller group have a chickenpox booster on the schedule. The US leads the pack of countries with a 2 shot schedule, and following along are Ecuador, Saudi Arabia, Germany, Greece, and part of Australia.

Some countries give the shot to adolescents, others offer it to members of “risk groups”… and a few have a one-shot schedule for toddlers: Canada, Costa Rica, Uruguay, Cyprus, Latvia, and Korea. A grand total of 26 countries offer the shot in one way or another. [1]

The US was the first country to recommend the shot for all toddlers, in 1996 :

…. empiric data on medical utilization and costs of work-loss resulting from varicella were used. The results of this study, which were determined using an estimated cost of $35 per dose of vaccine and $5 for vaccine administration, indicated a savings of $5.40 for each dollar spent on routine vaccination of preschool-age children when direct and indirect costs were considered. When only direct medical costs were considered, the benefit-cost ratio was 0.90:1. [2] (emphases added)

But it turned out that a single shot of varicella vaccine didn’t work to suppress chickenpox.

…varicella outbreaks have regularly been observed in populations with high vaccination coverage and are the cause of sizable disease and economic impact for public health departments and the US health system overall. To further reduce varicella disease burden, a routine 2-dose varicella vaccination recommendation was approved by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) in June 2006 (first dose for children 12–15 months of age, second dose for children 4–6 years of age) . [3]

The single-shot regimen showed a narrow margin of benefit only when placed alongside income lost by parents staying home to care for sick children.

But when the one-shot program failed, the ACIP came up with another cost/benefit justification for the second shot where the evidence….

….included ongoing disease burden and varicella-zoster virus transmission, including transmission from breakthrough cases to high-risk persons that may lead to severe disease and even death (CDC, unpublished data); partial or complete susceptibility in 1-dose vaccine recipients as they become adults; the burden on public health agencies due to varicella outbreaks in highly vaccinated school settings, which have proven disruptive to society and costly to control; and the increased immunity and disease protection from a second dose. Overall, the 2-dose strategy still provides very high cost savings (>$0.9 billion from societal perspective). [3] (emphases added)

So the ACIP justifications for adding a second dose, used the consequences of their decision to recommend the first dose of varicella vaccine. These ingenious calculations created a bigger cost savings than their first round! Read more

Vaccine sleight of hand

July 18, 2010 by · 7 Comments
Filed under: Opinion, Parents' Pages 

Every Child by Two proclaims that vaccines save money! Lots and lots of money!

Childhood Vaccines Save Lives and Money

But then, on the side of their web-page, is a link to a graphic illustration of the rising costs of childhood vaccination.

Looks like they want it both ways: “vaccines save billions” by reducing health care costs, preventing hospitalizations and doctor visits; BUT  “the newer vaccines are more expensive and we need to put a lot more tax dollars into vaccination programs.”

If the numbers with respect to “dollars saved” were solid and existed across the entire vaccine program, the argument would be a good one. Upon further scrutiny, it looks like they are pulling a bait and switch. They put forward some old numbers based on the less expensive vaccines combined with some inflated statistics for predicted epidemics (see the “33,000 deaths prevented” link above for our detailed analysis of these numbers), then slide right past the huge increase in the number and cost of vaccines in the current U.S. schedule.

On top of this, some of the newer vaccines are aimed at illnesses which are of low incidence or fairly mild in most children.  For example, Hepatitis B is very severe, but it isn’t common among infants born in the U.S. On the other side, chickenpox is usually a minor illness, although common. The chickenpox vaccine cost benefit justification actually depended on a monetary estimate of the cost of parental time lost from work. Some convoluted bookkeeping methods would be needed to demonstrate that universal vaccination with ALL of the vaccines on the current schedule results in overall health care savings. There is certainly no sign of these savings in the escalating cost of health insurance in the U.S. Read more

Indian Physicians slapped with anti-vaccine label!

July 8, 2010 by · 2 Comments
Filed under: News, Opinion, Vaccine Science, WHO Watch 

Why? Because they questioned a WHO (World Health Organization) diktat in favor of universal Hib vaccination in India.

Sorry, but this is getting ridiculous. Anyone, at any time who raises any concern about the safety, efficacy, or appropriateness of any vaccine is now called anti-vaccine.

Here is a potted history of the recent outbreak of name-calling.

In the July 2010 issue of the Indian Journal of Medical Research this editorial appeared: Introducing pentavalent vaccine in the EPI in India: A counsel for caution.

The latest WHO position paper on Hib says ‘Hib vaccine should be included in all routine immunization programmes. This suggests that Hib vaccine should be included in the immunization programme universally, irrespective of an individual country’s disease burden, not withstanding of natural immunity attained within the country against the disease, and not taking into account the rights of sovereign States to decide how they use their limited resources. The mandate and wisdom of issuing such a directive, for a disease that has little potential of becoming a pandemic, needs to be questioned.

The editorial reviews the available data and on the basis of the science, questions the need for the Hib vaccine in India.

In response to this thoughtful challenge to the WHO policy on Hib, a news commentary was published in the BMJ (British Medical Journal) which called the concerned doctors an “anti-vaccine lobby.”  This article, which is unreferenced, claims:

The Hib organism, which can cause severe bacterial meningitis and pneumonia, is estimated to kill more than 370 000 children worldwide each year, GAVI said. Nearly 20% of these deaths occur in India.

In response to the BMJ article, a rapid response was published in the online version of the BMJ by eight members of the supposed “lobby”

The doctors wrote:

The thrust for including Hib vaccine in India is based on 2 arguments. The first is that there is anecdotal evidence of the existence of Hib disease and Hib meningitis in India and that Hib meningitis may lead to long term morbidity. The second argument is that the well-to-do parents sometimes buy Hib vaccine in the open market to vaccinate their children. The Government of India must therefore provide it free for the poor, on the grounds of equity and fair play (2).

The problem with the anecdotal reports is that they do not specify the size of the universe from which the samples are drawn and public health policies cannot be based on these figures without a denominator. The many systematic surveys done to look at the magnitude of the problem of Hib disease in India have nearly always shown that the incidence of Hib disease is much lower than what was projected for India. Most of these studies have been funded by the WHO and these have been reviewed recently in an open access journal (3).

So, we have the BMJ calling names and publishing an unreferenced attack claiming high numbers of deaths from Hib, while the supposed anti-vaccine lobby provides carefully referenced information debunking the claims.

The pro-vaccine lobby has plumbed to new depths.

Polio and Sanitation

KHAGARIA: On the sandy banks of Kosi river in north Bihar, a quiet crowd of several hundred people is waiting in the sizzling morning sun. A speck appears in the pale blue summer sky, rapidly growing in size — its a gleaming white helicopter. Within seconds it is hovering above the opposite bank, amidst the cornfields.

The crowd is awestruck at the monstrous machine as it settles down in billowing clouds of sand. Out comes the man everybody has been waiting to see — Bill Gates.

Bill Gates has come to find out why polio eradication is failing in Bihar. He asks questions about immunization strategies and tries to figure out what sort of technical problems are blocking universal vaccine delivery.

People complain of lack of basic health facilities…There are only 49 auxilliary nurse and midwives under the PHC, against a sanctioned strength of 76…So, the delivery of basic health services is itself a distant dream…The villagers hope against hope. Isn’t the spread of polio linked to lack of sanitation and basic health facilities? Gates acknowledges this fact but says that it is for the government to do the needful. “We are concentrating on the eradication of polio, which is achievable through vaccines,” he says. [1]

Polio epidemics first appeared in the mid-nineteenth century. Many doctors and scientists struggled with the mystery: why, as living conditions improved, did incidents of paralysis increase? Out of all the changes that came with modernity, improved sanitation was chosen as the change which caused polio to turn from a mild illness to one that left death and permanent damage in its wake.  Here is an excellent example  from a 2007 medical article which summarizes the concept:

Prior to the 20th century, virtually all children were infected with PV while still protected by maternal antibodies. In the 1900s, following the industrial revolution of the late 18th and early 19th centuries, improved sanitation practices led to an increase in the age at which children first encountered the virus, such that at exposure children were no longer protected by maternal antibodies. Consequently, epidemics of poliomyelitis surfaced . [2] Read more

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