Meningitis vaccine
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To have the option of saving a child’s life and to reject it seems more than callous. It is the ugliest of affronts to human dignity. This sentiment is behind the largest ever public petition to the UK parliament. By Tuesday morning, a campaign calling for all children under 11, not just babies, to be vaccinated against meningitis B had acquired more than 750,000 signatures — far more than the 100,000 required to trigger a parliamentary debate.

Many signatories were stirred into action by photographs of dying children, posted by bereaved parents on social media.

Each photograph brings a statistical rarity wretchedly to life. In an era when government spending priorities on healthcare are shaped by data and statistics but the currency of democracy is social media, clashes between populism and prudence are inevitable. We are moving into perilous territory: a healthcare system that bends under the weight of public opinion runs the risk of overpaying for drugs and eventual collapse.

The brain and spinal cord are protected by membranes called the meninges, which become infected and inflamed in meningitis. The flu-like
illness can be caused either by a virus or, more worryingly, by bacteria. Bacterial meningitis is often associated with septicaemia (blood poisoning), which can result in amputation, organ failure or death.

The disease can move quickly and aggressively, especially in very young children, with meningitis B accounting for 90 per cent of the roughly 2,000 cases seen in Britain each year. About one patient in 10 dies. The infection is adept at hiding from the immune system, making it a tough therapeutic target, but the Swiss-based pharmaceutical company Novartis struck gold in 2013 with Bexsero, the first vaccine produced by “genome-based reverse vaccinology”. By 2015, Bex­sero was in the hands of GlaxoSmithKline and approved for inclusion on the UK’s immunisation schedule for under-ones. (Parents of older children are seeking the vaccine privately and supplies are running short.)

Since meningitis B is thankfully rare, it is difficult to evaluate Bexsero’s efficacy; the toll can fluctuate naturally and has dropped by roughly half over the past decade. The vaccine’s effectiveness has been deduced from lab tests only, which show that it stimulates the production of antibodies. The UK, in fact, is the only country with Bexsero on its childhood immunisation programme.

The main reason the vaccine has not been adopted for older children is cash. In the UK and many other countries, new therapies and vaccines must pass a stringent cost-benefit analysis, tied to a metric called “QALY” (quality-adjusted life years). The rule of thumb is that if a new treatment gives a patient an extra year of good quality life for £30,000, then it is worth the money.

In a system of finite resources, however, this means that for every treatment that is funded, another must be rejected. It is worth noting that when the UK’s Joint Committee on Vaccination and Immunisation first considered Bexsero in 2013, it rejected the vaccine outright, as not cost-effective at any price.

In an ideal world, we would all wish for every child to be vaccinated against every preventable disease, and for every sick person to get the very best treatment. In the real world, that would cost the earth and most people do not want to pay the taxes needed to sustain a healthcare system capable of satisfying infinite demand.

And so, alas, decent public health experts and epidemiologists must carry out the thoroughly indecent business of advising ministers on which conditions merit our money and, as a result of balancing the equation, which conditions should miss out. Sadly, social media rarely shows both sides of the equation.

The writer is a science commentator

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