Cost-effective? Surely a vaccine that could prevent the death of a child is cheap at any price
ABOX of matches. Probably not the most sophisticated diagnostic tool ever invented but, one fearful night when my eldest son was a baby, a box of matches saved me a midnight dash to the nearest A&E, and a whole world of anxiety.
Like all parents of young children, I lived in dread of meningitis and knew the signs to watch out for – fever, lethargy, poor appetite, aversion to bright light, odd rash, general grouchiness – and that night my ten-month-old baby seemed to tick enough of the boxes to justify concern. Before I bundled him up for the drive to the hospital, though, I rang A&E and spoke to a nurse on duty. All the advice for parents around meningitis recommends that you mention it, specifically, to the medical personnel just in case they don’t consider it themselves. I thought my little fellow had meningitis, I told her, should I bring him straight in?
Of course, she said, if you’re worried about the disease but, before you do, try this simple test that might help rule it out. Sit him on the floor and scatter a box of matches around him. If he looks down at the matches and tries to pick them up, it means he has no neck pain, one of the major symptoms of meningitis. I rang back to tell her he was sitting on the carpet, picking up the matches and attempting to eat them. Give him some Calpol and a little 7 Up (the universal cure for pretty much every childhood complaint), she said, keep an eye on him, but he sounds like he’ll be fine.
Afterwards, I wondered how many times a night that nurse found herself reassuring parents who were worried about meningitis – enough, clearly, to need a quick and easy test that might stop them racing to hospital with their sick infants, exposing their babies to more bugs at a time when their immunity was low and adding to the workload in already- overcrowded emergency departments. But, as that nurse clearly knew, you couldn’t blame parents for panicking at the first sight of a high fever, an obviously sick baby and a mark that might just be the beginnings of that ominous rash.
Meningitis is a stealthy killer, often masquerading as an innocent childhood ailment until it has inflamed the brain’s membranes and the spinal cord, and has progressed too far to be stopped by antibiotics.
Around 300,000 people a year are killed by meningitis, many of them babies and young children, and survivors are frequently left with life -altering conditions, including amputations and brain damage. And it is often misdiagnosed in its early stages, precisely because it mimics more harmless symptoms and because, too, overworked doctors and nurses don’t always listen to the concerns of worried parents: I can’t be the only mother to have been dismissed, in the most patronising tones, with the words ‘all babies vomit, mum’.
Factor in the medical negligence cases arising from these misdiagnoses, the hours of A&E time taken up by parents whose babies have nothing worse than a tummy bug, and the cost of treating those left disabled or brain damaged by meningitis, and the State’s on-going failure to fund the men- ingitis B vaccine, which has been privately available in this country for the past two years, doesn’t even make sense on an economic level, let alone a humane basis. As revealed in this paper yesterday, the vaccine costs as much as €180 a shot, with some babies sometimes needing up to four jabs. The National Immunisation Advisory Committee has recommended that the vaccine against bacterial meningitis – which is far more lethal than the viral form – should be included in the primary childhood vaccination programme. But, the committee added in a caveat, ‘only if it was available at a costeffective price’. In human terms, though, pretty much any price for such a drug is cost-effective.
Anyway, bulk-buying the drug Bexsero, perhaps in co- operation with the NHS which already provides it free of charge in the North and Britain, would surely reduce the price to a level at which even the economic benefits would far outweigh the cost. In the UK, it costs around €100 a shot, which economies of scale could cut still further if the two health authorities negotiated together.
Reaction
Aside from the money, though, there may be another reason to give the HSE pause at the moment – the inevitable risk attaching to every vaccine. At present, a Co. Westmeath mother, Fiona Kirby, is taking a High Court action against the Health Products Regulatory Authority, which monitors health products in this country, seeking to restrain the use of Gardasil, the vaccination against the virus which causes cervical cancer. In court earlier this month, Mrs Kirby claimed that her daughter, now aged 15, suffered a severe reaction to the vaccine when it was administered to her in school in 2011. After the schoolgirl got the second dose of the vaccine, Mrs Kirby claims, she began to exhibit flu-like symptoms. She subsequently suffered extreme fatigue, nausea, weight loss, muscle wastage and is now disabled to the point where she requires permanent care.
Mrs Kirby is a member of REGRET – Reaction and Effects of Gardasil Resulting in Extreme Trauma – and claims that far from being an isolated case, her daughter is just one of a number of girls suffering life-threatening health problems as a consequence of their reaction to the drug. Gardasil, like all vaccines, is offered to parents on an elective basis. It is not compulsorily administered in Irish schools, and is recommended by the World Health Organisation as an effective safeguard against cervical cancer. Mrs Kirby’s action, which is back in court this week, seeks to have it withdrawn from use in this country.
Mrs Kirby is not alone in opposing the use of Gardasil, and critics worldwide accuse ‘Big Pharma’ of whipping up anxiety about a condition that isn’t nearly as dangerous as the vaccine – there’s a 2.5% chance of an adverse reaction to Gardasil, whereas the risk of cervical cancer is estimated at .75% – just to make money.
But if there wasn’t money to be made, then ‘Big Pharma’ wouldn’t spend billions developing vaccines in the first place: they are businesses, not charities, and it is disingenuous to berate them for seeking to profit from the healthcare innovation that has single-handedly reduced the sum of human misery over the past century, the vaccine.
Without companies willing to invest in research with the intention of making money, we’d still be succumbing to smallpox, polio, measles and rubella, and HIV would still be a death sentence rather than a chronic condition. It’s important to remember, too, that vaccinations are a voluntary precaution. While our Department of Health strongly recommends childhood vaccinations, they cannot be administered without parental consent. This is true of the Gardasil jab, and, if it ever becomes publicly available, will also be true of Bexsero. Arguably, however, health authorities need to be far more forthcoming in alerting patients to the potential side-effects of vaccines and, to that end, we all need to remember how exactly a vaccine works.
It operates by administering a tiny dose of the disease to the patient, encouraging the body to build up its immunity so that it will be better equipped to fight off the real thing. But there’s no ignoring the fact that this practice has to carry a risk of a bad reaction, and it is a judgment that parents have to make: do you deliberately expose your child to a disease that might never trouble them at all, in the hope that they will have the resources to fight it if it does? Or do you cross your fingers and hope for the best?
Bexsero is thought to offer up to 73% protection against meningitis B – which is an appealing statistic to anyone who has ever made the midnight dash to hospital with a feverish, vomiting, distressed infant in the baby seat.
Fortunately, I was one of the lucky ones. When I thought my little fellow had meningitis back in the late Nineties, long before a vaccination was ever heard of and a box of matches was a useful, but not particularly sophisticated, diagnostic tool, I was wrong. Brian Cavanagh, who promptly took his 12-year-old daughter Elizabeth to hospital when she came home from school with flulike symptoms back in 1993, was not. She was dead within 24 hours of falling ill.
A few hundred euro and the outside chance of a bad reaction seems a small price to pay if such tragedies are within reach of being prevented.