Six Reason to Question Vaccinations

[Ivor the Engineer]

Do you think that there is no money being spent on those ten causes of death? Or throwing an additional $450m, if spent on those causes and not on vaccinations, would result in fewer deaths?

I should have said "an extra $450 million", and yes, I'm confident spending an extra $450 million on other illnesses could save more than 100-150 lives per year. For example, if the figures on influenza are to be believed, spending it on vaccinating an extra 20-30 million Americans against flu would save more lives each year.

 

[Ivor the Engineer]

Can you be a bit clearer on your statement on vaccination?

I shall try.

The expenditure in order to save one life is one method of assessing the suitability for a medical intervention. For vaccinations in general, the benefits are usually unquestioned, and certainly a no-brainer for diseases like diphtheria, pertussis, measles, Hib, meningococcus and so on. Vaccines such as Gardasil may save lives, but there is a higher cost involved. Some vaccines may not particularly "save lives", but may avert illness that is rarely fatal but can be unpleasant (hepatitis A, chickenpox). For these interventions, one needs to consider indirect costs and benefits carefully. Not all vaccines are equal, medico-economically speaking, so it doesn't make sense to put them all in the same category.

Vaccines are a simple and generally safe method of saving lives. Contrast this with the costs of (say) statins or coronary bypass to prevent a death from myocardial infarction, liver transplants for hepatitis C, or vioxx to make someon'e arthritis better. I think if you wish to question the benefits of medical interventions, there are plenty more battlefields that would be suitable for your fight than the vaccine one.

This is where rationing based on need comes into the equation. Vaccinating healthy children against chickenpox is not needed for the vast majority of them. A liver transplant for hepatitis C is needed. It is therefore justifiable (ethically) to spend more on those with greater need.

Clearly a balance has to be struck between using resources efficiently (i.e. minimising suffering by the maximum amount) and ethically (i.e. reducing the suffering of those suffering the most), since they often result in very different distributions of resources.

No doubt when you have angina, you will be happy that your doctors limit your treatment to GTN spray, on the basis that investigation and interventions like angiography are not really cost effective when considering the general health economy and that the money could be more fruitfully spent elsewhere.

That would depend on my need relative to other peoples' and how much improvement can be obtained from treatment.

This may help you understand my thinking better.

Equity and Distributive Justice

A possible criticism of the utilitarian or QALY based approach to resource allocation is that it does not provide an equitable or fair way of distributing resources.

Aristotle, explaining his view of distributive justice, says, in effect, that equals should be treated equally, and unequals treated unequally in proportion to the relevant inequalities. This is known as Aristotle's "formal principle of equality". Its value lies in its implicit demand that we spell out the criteria we are using when we call people equal or unequal. Aristotle's own criteria were based on merit; modern criteria may (or may not) be based more on need.(Nichomachean Ethics 1131a-1131b. See for example the edition of Crisp R, Cambridge, CUP, 2000 pp 85-87). The utilitarian or QALY based approach could be said to treat unequals equally, in that it does not take account of differences in need for health care but focuses entirely on the benefit gained from an intervention. Some individuals or groups of patients will have poorer health than others, or more serious diseases, and will have a greater need of health care. If degree of need is a main criterion, a just distribution of health care resources may require that these individuals or groups have more resources, even if the benefit gained by treatment is small compared to that achieved by a different treatment in patients who are less sick.

 

[Deetee]

I shall try.

Thanks, Ivor.
I actually had meant Robinson....

I should have quoted him, I realise.
This is what he said:

Until this topic, I never considered money and how many lives could be saved for the same amount, in regards to vaccination programs.

It is indeed a reason to question vaccinations.

Clearly you are a very active young man and will never get angina. Robinson, OTOH, sits in a chair and smokes a pipe (although he has recently stopped, I see)

 

[Skeptic Ginger]

Ivor, you cited a cost effectiveness report that concluded:

CONCLUSIONS--A routine varicella vaccination program for healthy children would result in net savings from the societal perspective, which includes work-loss costs as well as medical costs. Compared with other prevention programs, it would also be relatively cost-effective from the health care payer's perspective.

then just went on a rant that it must be drug company profit influenced. If they analysis showed $5 saved for every $1 spent, even if you used 2 doses you'd have $3 saved above cost. You have your conclusions drawn before you look at any of these reports.

 

[Ivor the Engineer]

Ivor, you cited a cost effectiveness report that concluded:

CONCLUSIONS--A routine varicella vaccination program for healthy children would result in net savings from the societal perspective, which includes work-loss costs as well as medical costs. Compared with other prevention programs, it would also be relatively cost-effective from the health care payer's perspective.

then just went on a rant that it must be drug company profit influenced. If they analysis showed $5 saved for every $1 spent, even if you used 2 doses you'd have $3 saved above cost. You have your conclusions drawn before you look at any of these reports.

The study was performed in 1994, when it was assumed only 1 dose would be required (and they underestimated the true cost of that too).

My conclusions are:

1) There are still a lot of unknown factors (e.g., waning immunity, boosting from exposure to wild-type VZV) which could make routine varicella vaccination of children cost much more than has been estimated, negating any cost-savings.

2) I find the ethics of spending huge sums of money on a vaccination programme justified using the socioeconomic benefits it provides to parents questionable, especially when similar amounts of money could save the lives of many more people, or reduce greater suffering caused by illnesses other than chickenpox, at the individual level (in the same countries where routine childhood varicella vaccination has been implemented).

(1) is a wait and see issue. (2) is based on my personal values.