Journal roundup: Assessing parental doubts; Cost-effectiveness models in vaccine policy-making

As we do periodically, here are some papers of note published recently in the medical literature. (All require a subscription in order to view the full text.)

• "Parents with Doubts about Vaccines: Which Vaccines and Reasons Why" (Pediatrics, Vol. 122, No. 4, 718-725); A survey of nearly 4,000 parents aimed at understanding the factors contributing to doubts over vaccinating their children or decisions to delay or reject vaccines. The authors note the impact of vaccine safety concerns -- some specific, others general -- on parents with doubts about vaccines and the role of information from physicians in causing parents to change their minds and proceed with vaccination.

• "The Role of Economic Information in Decision-making by the Advisory Committee on Immunization Practices" (Vaccine, Vol. 26, Iss. 42, 5389-5392); A survey of ACIP members' views regarding the use and importance of economic data -- principally cost-effectiveness analyses -- in the development of ACIP recommendations. (While published this fall, the study interviewed the 2006 ACIP membership. This summer, guidelines regarding presentations of economic data were issued by CDC, attempting to address suggestions raised in this survey and elsewhere regarding the standardization of economic presentations.)

• "Funding of Drugs: Do Vaccines Warrant a Different Approach?" (Lancet Infectious Diseases, Vol. 8, No. 11, 727-733); Another paper on the impact of population-level economic analyses on vaccine policy. The authors detail some of the unique characteristics of vaccines and vaccination programs (compared to pharmaceuticals) that make cost-effectiveness analyses more complicated for vaccine policy-makers. Includes examinations of several specific vaccines and the challenges they raise for economic analyses of their impact across populations.

Vaccine business booming for pharma; Financing gaps for uninsured children

While we've been away in August working on the new VaccineEthics.org, a few items appeared that highlighted two very different angles of vaccine financing, cost, and profitability.

Last Sunday's New York Times noted how "Vaccines and Their Promise are Roaring Back." The story highlights the oft-repeated account of the surge in research interest from pharmaceutical companies, new products, and huge profit growth in vaccines in recent years.

Amid all this enthusiasm for new vaccine development, the story all but ignores the many challenges required to produce and deliver safe, effective, and affordable vaccines. Its conclusion captures the tone of the entire story:

"The allure of the silver bullet -- of wiping out an entire class of related diseases with a single injection -- remains a powerful symbol of technological advance. Fifty years ago, vaccine creators captivated the world's imagination. With the return of vaccine-making to the center of the pharmaceutical business, new sources of profits are emerging, and new heroes of innovation."

Speaking of challenges, a report published in JAMA earlier this month noted "Gaps in Vaccine Financing for Underinsured Children in the United States." (subscription required for full text). The CDC-sponsored study offers a useful overview of the varied programs that finance vaccines for uninsured or underinsured children. The authors' data confirm the long-standing belief that a significant percentage of underinsured children are not receiving all recommended vaccines due to shortfalls in state funding and federal discretionary spending. An accompanying editorial by Matthew Davis ("Reasons and Remedies for Underinsurance for Child and Adolescent Vaccines") examines the causes and possible solutions to this problem.

From Vaccine: Examining vaccines' economic value

A noteworthy paper in the issue of Vaccine dated August 10 examines assessments of costs and benefits for vaccines and vaccination programs. Titled "Do we fully understand the economic value of vaccines?" (free abstract), the implied answer is fairly obvious (or there'd be little need for another paper on the topic).

Anyone who has attended a meeting of the ACIP has seen firsthand the growing attention given to cost-effectiveness studies of a new vaccine prior to a decision on recommending its use. This paper, by Drummond and colleagues, examines cost-effectiveness data for several widely used vaccines and compares policies among developed-world countries for these vaccines. Among its conclusions:

• "The vast majority of vaccine strategies are cost-effective, when compared with accepted thresholds of cost-effectiveness."
• "Standard methods of economic evaluation...may underestimate the true economic value of preventive strategies such as vaccination."
• "Current vaccination policies in developed countries are generally in line with the existing evidence on cost-effectiveness, although they often lag behind."
  

An excellent paper addressing an issue of growing importance to vaccine policy in a time when vaccine prices are reaching new highs.