Review: The average cost of measles cases and adverse events following vaccination in industrialised countries

One of our readers posted a comment asking us: “Can you tease out some facts in this study?” We think we could probably write several papers discussing the issues surrounding this study: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC128813/ but we will provide a brief summary because a study such as this isn’t worth spending an inordinate amount of time on.

We are going to make a few opening caveats:

1) Some of us believe that measles might be the only vaccine that is justifiable on a large population basis and that is only because there is some evidence that measles can have a relatively high (still low on an absolute basis) rate of serious side effects in some populations.
2) Cost justification studies (such as this) are usually based on a house of cards, and are only as good as the data that underlies the layers of assumptions made in the model.
3) Cost justification studies that are used to support mass vaccination mandates almost invariably turn out to be wrong due to underestimating the cost of the vaccine program and side-effects and overestimating the effectiveness of the vaccines.
4) These studies are often misleading because they are usually sensitive to a few key assumptions and they normalize everything to a dollar value. Here is a sample problem with normalizing everything to a dollar value: let us imagine we have two different vaccines that we want to give to 1 million people. In the testing, 50% of the people suffered 3 days of mild illness causing missed work with no long term effects from vaccine A. 1 person died from vaccine B with no one else suffering any ill effects. The cost of vaccine A would be far higher in almost any financial model, and yet clearly we would much rather fall mildly ill for 3 days rather than risk a 1 in a million chance of dying.

This particular study is interesting in that it is not actually performing a cost comparison or justification. It is only trying to set the cost of a measles case and the cost of a measles vaccine reaction. In order to judge the likelihood of bias in a study, a quick check on the authors reveals that although there are no direct conflicts of interest declared, several of them work for organizations which were desperate to defend the MMR vaccine in the wake of the Wakefield papers from around that time period. There is nothing wrong with that, but it provides context for the timing, content, and potential bias’ of the study. Read more

Tuberculosis Vaccine Use Based on “Blind Faith”

November 8, 2010 by · 6 Comments
Filed under: Vaccine Science, Vaccine/Disease Analysis, WHO Watch 

UK is planning to introduce the BCG vaccine for all newborns in London because of a resurgence of the disease. The article states:

Health experts believe the threshold at which routine immunisation is required — 40 cases per 100,000 — has been reached across the capital. Current policy has been to offer vaccination to children who are born abroad or whose parents are born abroad. [1]

Why is it that Spain and the U.S. have never used the vaccine and yet have a very low incidence of TB?

The BCG vaccine is the most widely used vaccines of all, as well as the most controversial. The first BCG vaccine trial resulted in a huge disaster which seriously marred its reputation.

The Lubeck disaster will remain a landmark in the history of immunization. In the summer of 1930, in Lubeck, Germany, 240 infants were vaccinated with BCG; 72 of the vaccinated infants developed tuberculosis and died….

Nevertheless, the disaster had done much to harm public acceptance of the vaccine, and mass vaccination of children was only reinstated after 1932, when new and safer production techniques were implemented. Its efficacy has been found to range from 0-80%. [2] Read more

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

Eradicate Chickenpox? Sure! Why Not?

March 20, 2008 by · 9 Comments
Filed under: Vaccine/Disease Analysis 

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Chickenpox

Look back to the time of the earliest humans and you’ll find chickenpox. Anywhere you go on the planet, you find human beings who carry and share the virus. No remote village or tribe on Earth has ever been discovered to be free of this virus. Quite an achievement! For the virus…

Scientists have studied small, isolated populations, trying to understand how the virus survives; it has a unique survival strategy we call “shingles”.
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