Courtesy flickr user zmxncbv.com
The think tank 2020health has just released my report on UK vaccination policy. ‘Not immune: UK vaccination policy in a changing world‘ was written in response to the Conservative Party’s call for the UK’s Joint Committee on Vaccination and Immunisation (JCVI) to be merged with the National Institutes for Health and Clinical Excellence (NICE). Drawing on interviews with senior vaccination policy-makers and an exhaustive review of the literature, the report concludes that while a merger would be more likely to harm rather than benefit the UK’s health, there is a strong case for more open and transparent immunisation policy-making.
The JCVI is currently quite a secretive body which conducts its meetings behind closed doors, only releasing minutes to the public a couple of months later. So far, this hasn’t caused any problems, but as the MMR vaccine scare and other health crises such as BSE and foot and mouth have shown, it’s impossible to predict what is around the corner, and if the JCVI should ever make a wrong decision (as its counterpart in the US recently did by introducing a dangerous rotavirus vaccine that subsequently had to be withdrawn), its secretive modus operandi will come under scrutiny. Trust is crucial for vaccine decision-making (unlike with the treatments for sick people that NICE evaluates, with immunisation parents are taking healthy children for jabs), but secrecy and trust are unlikely bedfellows. We therefore recommend that the JCVI open its meetings to the public and allow some public participation (which is likely to come as a shock to some JCVI committee members).
Another key message (there are quite a few recommendations but I’m afraid you’ll have to read the report for a full list) applies to both the JCVI and NICE. The cost-effectiveness of treatments and vaccines is a fundamental part of decisions on whether to introduce them into the National Health Service, but neither body has effectively made the case that cost-effectiveness is important. We therefore get regular outraged headlines in the Daily Mail and other boneheaded rags that decisions to reject drugs are based “purely on cost,” as if a health service with limited resources should take no account of expenditure. NICE in particular should be more open about why it has to take account of cost-effectiveness, and about how this will benefit the nation’s health. Until then, it will continue to lose the media war, and its reputation will continue to take a battering.
