Vaccine evaluation: lessons from a meningococcal B vaccine

Vaccination is among the most effective public health interventions of the past century, with immunisations against some of the most common and devastating childhood infections already in use to great effect. The development of new vaccines depends on advances in the field of vaccinology that carry high monetary costs. In most countries, these costs pose an obstacle to adoption of new vaccines. To that end, together with the scientific evaluation of new vaccines, an economic evaluation is vital. This aims to determine whether investment in the proposed vaccine is worthwhile. In this article, we will examine one such case study: the evaluation of a new meningococcal B (MenB) vaccine in the UK by the Joint Committee on Vaccination and Immunization (JCVI). We are well aware of the constraints imposed by a definite health budget; at the same time, we would like to raise awareness to the problems inherent in and the somewhat speculative nature of the economic model when applied to vaccine evaluation. Though some of the aspects of this case are specific to the UK, the principles of this evaluation are relevant to all modern health systems. In March 2014, JCVI made public its decision to support the introduction of a MenB vaccine (Bexsero) that had been licensed for use in Europe the year before.1 ,2 JCVI recommended that the vaccine should be introduced into the UK routine infant immunisation schedule if the appropriate price per vaccine dose could be negotiated. This decision is welcome news to the medical profession, to meningitis patients’ advocacy groups, to the population in general and to the vaccine manufacturers. The process by which Bexsero was recommended highlighted the central role that health economics and cost-effectiveness analysis play in such decisions. The difficulties that JCVI faced when reaching its eventual decision suggest …