Vaccines, Who Should Decide?

Published May 24, 2011

One of the most significant questions facing the country on health care policy in the wake of President Obama’s nationalized reforms is who ought to make decisions about which products are available, and for whom.

Obama’s plans involve a major bolstering of top-down rationing from Washington—particularly through the Independent Payment Advisory Board (IPAB), a group of unelected and unaccountable bureaucrats and experts whose price-focused rationing policies will go into effect unless a supermajority of Congress overrules their decisions. In the president’s recent remarks outlining his solution to deficit problems, he doubled-down on IPAB, calling for even more authority for the board, which is effectively insulated from transparency and any real challenge on the part of American citizens.

Yet this is hardly the only area where such autocratic, top-down approaches to cost-focused crackdowns—which do nothing to improve the quality of care—are being espoused by Washington. Consider the current approach of the Centers for Disease Control (CDC) and their Advisory Committee on Immunization Practices (ACIP) to the meningococcal vaccine for infants an example of the kind of approach you’re likely to see more of in the future.

Meningitis is a rare disease, but it’s a leading cause of preventable deaths in infants—one in sixteen who get the disease die of it—and horrifying stories of infants with amputated limbs are something we all want to avoid. The good news is that the Food and Drug Administration (FDA) has already approved a new vaccine for infants and will soon approve more—vaccines created after ACIP pushed strongly for eradicating the disease roughly a decade ago, following the example pursued successfully in the United Kingdom with a mass vaccination.

Yet in the wake of dropping meningitis rates, the authorities in Washington and Atlanta appear to be reconsidering their cost-effectiveness analysis of this vaccine. The CDC has historically never chosen to not recommend a vaccine for children which has been approved as safe by the FDA, but in this case ACIP seems to be dragging its feet.

This week the CDC is hosting a national “stakeholder” meeting in Washington, D.C.  to discuss issues surrounding future access to these new infant meningococcal vaccines. Yet the meeting has not been announced to the press or the public, and the CDC’s website offers not a shred of information about it.

The CDC is also quietly planning a series of four “public” meetings around the country to decide whether to recommend the vaccine and put it on the infant schedule. These meetings are expected to take place in New Hampshire, Colorado, Illinois, and Washington state over the summer—but like the national stakeholder meeting, no information is publicly available.

As a general rule, whenever you hear about non-transparent meetings of stakeholders, it’s not a good sign. There’s a pronounced lack of information available on the participants in these stakeholder meetings and there’s been little publicity surrounding them. The question that should concern parents is whether this listening tour will become part of an attempt to give the CDC cover for an unwise decision—based on dollars and cents, not quality of care—which would place an estimated 40,000 infants at risk over the next decade.

Whether this vaccine is added to the infant schedule or not, for ACIP not to at least partially recommend of a vaccine whose safety has been endorsed by the FDA makes for a dangerous precedent. It would result in a significant disincentive for vaccine makers in the future, and would be a sign that decisions about such vaccines will now be made by those with green eyeshades, not stethoscopes.

While meningitis rates are currently low, it’s a cyclical disease where there are huge upticks at around the twenty year mark—an increase for which we’re overdue, and need to be prepared to combat. And as one of the first major decisions made in the wake of the bogus controversy over autism and the measles mumps rubella (MMR) vaccine, this clumsy process runs the risk of catering to the anti-science fearmongers whose lies about vaccination risks have resulted in a return of preventable disease. It also could set a dangerous precedent about the decreasing value of human life.

Parents and doctors should be the ones making decisions about care for their children. The real question for health policy going forward is whether Washington’s unelected bureaucrats will overrule them.

Benjamin Domenech ([email protected]) is a research fellow for the Heartland Institute and managing editor of Health Care News.