Was it worth it?
The Herald reports:
Fewer than half New Zealand’s young children are thought to be still protected against the meningococcal disease epidemic, despite a $200 million mass vaccination campaign.
So we know the cost. What are the benefits?
The centre’s clinical director, Dr Nikki Turner, said yesterday the mass campaign was justified,”because we are talking about a reduction in disease and deaths in children … “
Obviously a good thing, but more specifically:
Statisticians have calculated that in the two years after it started, the vaccination programme prevented 54 cases of disease and 1.7 deaths.
Now it seems very heartless but agencies over the years have a value for a human life, so that decisions can be made on whether a particular road improvement or new drug etc is worth investing in. It used to be $2 million and I think might now be $5 million. Someone out there will know.
Is $200 million a good investment for preventing 2 deaths and 54 infections? Purely on a numbers basis, it is arguable it was not.
Now again, this may seem a harsh judgement. But the reality is, money is limited. Another way to look at it, is could more lives have been saved if the $200 million had instead been spent on elective surgery or Herceptin?
Now I am not saying conclusively the campaign was a bad idea. One should not decide those things off a newspaper story. There will be a mass of data to be considered. But on the face of it, it does appear to have been of debatable value for the investment.
July 22nd, 2008 at 8:16 am
It’s the .7 of a child I feel sorry for…
July 22nd, 2008 at 8:17 am
DPF, to be harsh about it, get back to me when you’ve buried a child.
July 22nd, 2008 at 8:25 am
the other question is were any children made sick by the vaccination?
July 22nd, 2008 at 8:33 am
Craig,
I have. So if I was asked to make a choice that meant a risk of 2 child deaths over 2 years or making a decent dent in the youth suicide rates in NZ it would be a no brainer. I would still mourn the 2 though.
July 22nd, 2008 at 9:37 am
At the time of planning a vaccination program the possible number of children that may have died or been affected was an estimate.
Whether the estimate was fair or foolish I don’t know, but it is the decision process that should be examined, not the eventual number of casualties.
July 22nd, 2008 at 9:41 am
If the 200 million was retained by the original taxpayers in the first place, that’s quite a few dollars for each family that could go towards doctors fees, enabling a wide range of ailments in the whole family that actually do occur to be detected earlier and treated – not just the one disease for one child that may not even occur.
It is definitely money that could have been spent more wisely.
July 22nd, 2008 at 10:17 am
It’s the law of politics. Highly visible disease, have to be seen to be doing something. And many who work in the field consider only the benefit side, with no interest in costs – they don’t have to deal with opportunity cost or the fact that our health budget is limited by our wealth as a nation. I agree that some of our public health policies are sub-optimal for political reasons.
July 22nd, 2008 at 10:21 am
As the Dad of a young toddler who’s been through this Menz vaccination I’m astounded to learn that the effectiveness lasts just a matter of months. I’d assumed it would be like other vaccinations and offer at least 10 years or so of protection, if not a lifetime.
Many years ago a friend of mine died from meningitis, so I’d supported vaccinating my daughter against it. But given today’s revelations of the lack of long-term protection and the relatively low occurrence rates I’d say that we could have better spent that $200 million elsewhere in the health vote.
July 22nd, 2008 at 10:55 am
“If it saves one life…” is worthless as an argument as far as I am concerned. The best thing to do is confront it with “If saving that one life meant four other lives went unsaved…”.
July 22nd, 2008 at 11:14 am
Using that argument, why bother immunising children at all — because no vaccine is 100% effective, and I’ve yet to come across anyone in the health sector who complains their patch is over-funded, over-staffed and could do with a budget cut. I don’t mean to be insensitive to you, david, and hope I don’t come across that way, but you could ask the same questions about the cost-benefit ratios in so-called suicide prevention programs. My point, in my original comment, is that it’s very easy to play the numbers when you’ve not seen your child die — or survive on to be horribly disfigured or disabled as a consequence — of meningococcal disease.
July 22nd, 2008 at 11:20 am
Craig, all health policy is about the numbers. The only real way to not have to make these choices is to get wealthier as a nation (and even then, the choices don’t go away, the line just gets drawn at a higher level of funding).
July 22nd, 2008 at 12:26 pm
> DPF, to be harsh about it, get back to me when you’ve buried a child.
Craig, how many kids die each year? Hundreds. To spend tens of millions trying to prevent the death of each one would bankrupt the country. Forget about tax cuts, forget about social services, superannuation, etc, etc.
The fact is that alarm bells were ringing before this vaccine was introduced. Norway tested the parent vaccine and said that it didn’t stack up. It simply wasn’t effective enough to justify the cost. And Norway’s “epidemic” was on the wane, just like ours was. The numbers contracting the virus dropped dramatically in the months and years before the vaccine was introduced, making the vaccine’s roll-out unnecessary.
July 22nd, 2008 at 12:28 pm
The disfigurements caused by Meningococcal disease are horrible, and it’s a communicable disease. I wonder if/how that was factored into the calculations?
PS: DPF is absolutely correct, young engineers in road-building class learn that a dollar “value” has to be assigned to a human life when assessing risks, otherwise it is simply impossible to rationally weigh up things like “Should we re-align this curve or that one, given that we can only afford to do one?”
July 22nd, 2008 at 12:30 pm
The debacle over the MeNZB vaccine is discussed here.
http://www.scoop.co.nz/stories/HL0502/S00064.htm
July 22nd, 2008 at 12:54 pm
And the chances of dying from the disease? About 1 in one million. Unlike the much higher probability of dying from a workplace accident.
http://www.scoop.co.nz/stories/GE0501/S00021.htm
July 22nd, 2008 at 1:47 pm
Almost certainly more women with breast cancer could have survived or had extended remissions if hercepton had been made availiable. I think the cost quoted was thirty million,,,As for the menniingcoccal jab there were numerous severe re=actions to it.
July 22nd, 2008 at 2:18 pm
RRM: strictly speaking, you could compare which bend to straighten without putting a value on a human life – you could do it in lives saved per dollar spent. But if you want to compare elective surgery against preventative medicine against road realignment against anti-smoking measures, you need some sort of objective measure. The standard is something like “quality of life adjusted years saved” (can’t remember the exact term) – basically we work out how many full years of life we save, we deduct for lower quality of life (a year saved of someone in intense pain from terminal illness is worth less than a year saved of someone full healthy etc).
I can’t remember all the ins and outs, but I completely agree it isn’t possible to have a rational public policy debate on many matters unless you have some understanding of how much it is worth to prevent one death, and therefore how much it is worth spending to prevent that death.
If we purchased everyone in NZ a new BMW it would probably save a lot of lives on the road, I’m not sure it would be seen as cost effective. Equally, if we set the open road speed limit to 50km/h it would save a lot of lives, but again the people of NZ might not feel that was a price they were prepared to pay to save those lives.
July 22nd, 2008 at 2:24 pm
Point made Craig, I suppose I was trying to draw a parallell about relative rates of occurrence and where the “best bang for the buck” might be had.
As an economist I can recognise that it becomes largely a statistical exercise (much as DPF has noted) of the allocation of scarce resources. If I was a politician however I would have been all over the vaccination like a rash ‘cos there is much more publicity mileage in it regardless of the cost/benefit ratios. I don’t envy anyone having to ration funds out in the health sector as it is full to overflowing with heartwrenching stories about how some more money here, there and everywhere could have saved lives or prevented death/illness/lifetime effects etc. RRM (bless his cotton socks for there is possibly some hope left for him) draws a very good parallel with road safety. Perhaps I should have used men’s health initiatives and a prostate screening service instead of suicide prevention as the alternative, to highlight the relative marginal benefits of spending the dollars one way or the other.
I do have a bit of a bee in my bonnet though, about the lack of attention given to suicide and the crappy way the academic establishment clobbered about the only initiative in recent years (Yellow Ribbon) through some misguided PC bullshit about copycat potential and the methods of fundraising. (end of rant)
July 22nd, 2008 at 2:55 pm
I have had serious reservations about this vaccine from day one. Essentially, the New Zealand public have been relentlessly misinformed and conned into unwittingly taking part in a clinical trial. . The vaccine was never subject to a phase III trial before being used (that’s a trial that uses large numbers of people as opposed to the phase II trial which usually uses a few hundred people). The vaccine was approved without phase III data by invoking “medical crisis” laws (Tamiflu, anyone?) in a manner that can only be called political manipulation. There was no medical crisis but the vaccine was popular as the government could then be seen to be doing something (Dog microchips, anyone?)
In the meantime, $200 million put into improving insulation and weatherproofing state houses would have easily saved a couple of children’s lives and vastly reduced the disease burden in those communities and been effective long-term unlike the vaccine. Of course, this sort of intervention is much more difficult to quantify and consequently does not produce any political kudos.
No one is saying that losing a child to meningococcal disease is not horrible and something that must be avoided if at all possible, but there is a finite amount of money available for health and we have a duty to spend it wisely. Meningitis is a disease that responds far better to alleviating the risk factors (such as overcrowding and poor sanitation) that it does to a temporary, expensive vaccine. It is really time that our politicians tried to act like a government instead of a bunch of political point scorers.
July 22nd, 2008 at 10:45 pm
NO
July 22nd, 2008 at 10:51 pm
You think that’s bad, just google “Gardisal.”
July 22nd, 2008 at 11:19 pm
Didn’t Labour get on the band wagon and “me too” the “grassroots” demand for “Gardasil”? Anything for the sisterhood.
On the bright side Labour still hasn’t succumbed to the demand to waste even more tax dollars funding Herceptin (R).
July 24th, 2008 at 11:49 am
You can probably add up those two figures; any “meninge” disease is of the meninges, which surround the brain. So any or all of those “54 infections”, while not leading to death, may leave the child brain damaged.
So, it’s possibly a saving just in terms of the amount of support that a brain damaged person will need over their lifetime… and $200m for 50+ good lives … heck you’d probably recover that just in tax revenue from them!