A Blunt Needle

It turns out the the immunity afforded by the much vaunted meningococcal vaccine is rather short-lived. This is not exactly a huge surprise, given the inadequate research done by Chiron in to the effectiveness of the vaccine. In fact their packet insert says.

“The degree and quality of the cellular immune response is not yet established.”

Which means, in layman’s terms, “we don’t know whether this stuff works”. And even better:

“No prospective efficacy trials have been performed with MeNZB.”

Translation: The reason why we don’t know is that we haven’t tested it properly, yet. And the real doozy:

“Adverse reactions were collected on the day of vaccination and each day following for up to 7 days.”

Now this is more subtle. It tells us that Chiron have done no long-term studies on side effects. Virtually the only side-effects they will have picked up in the first week after the jab is acute toxic reactions (allergies and poisoning) and sepsis (infection at the jab site). So we know that the vaccine is not poisonous. And that’s it. Given that the Norwegian version of the vaccine from which the NZ one is derived caused paralysis and chronic fatigue syndrome in rare cases, some long-term trial might have been prudent.

So why did New Zealand pay $200 million for a vaccine that may or may not work and may or may not have side effects? In a word – politics. At the height of the meningitis epidemic in 2001, the media were full of horror stories about meningitis victims, both the dead and the disabled. The pressure was on the government to do something. In January 2002, a fund of $100 million was announced to fund research into a vaccine. At this time, Chiron had already been contracted to convert the Norwegian vaccine, MenBvac, for use on the New Zealand specific strain. Scoop have an excellently researched article on the machinations of this contract.

It should be noted at this point that the Meningitis B strain was only the commonest strain of Meningitis in New Zealand, not the only one. When quoting statistics, it is important to look at only those for the New Zealand “B” strain, not all the others (which were not covered by the vaccine). Deaths from the “B” strain of meningococcal meningitis peaked at 17 in 2001 then dropped to 9 in 2002, 4 in 2003 and 3 in 2004, when the vaccine program commenced. The clear implication is that the meningococcal meningitis epidemic was already over by the time vaccinations began.

Of course, by this time the vaccine contract had been signed, sealed and delivered. It would have been politically impossible to back out of the vaccination campaign. But the really worrying thing here is the approval of the vaccine by the Medicines Assessment Advisory Committee. No phase III trial (trial using large numbers) had been done on the vaccine. Normally MAAC would not register any drug unless such a trial had been done. Therefore they could only pass this through as an emergency measure. But where was the emergency? The epidemic was over. It is therefore quite clear that MAAC succumbed to political pressure to pass the vaccine.

In effect, MAAC gave their permission to perform an uncontrolled phase III trial on 1 million New Zealand children and young adults without their permission and without fully informing them.

Call me old-fashioned, but that seems horribly unethical to me.

Now, at the end of this unethical trial, we find that the vaccine is pretty much ineffective, giving most children just a few months of immunity. (Cue the sound of politicians covering their butts…) Suddenly, at the same time, we have a friendly statistician saying that we have saved 1.7 lives and prevented 54 infections. This sounds great until you realise that it works out to over $117 million per life saved. And that this is only temporary. And the analysis is dubious for the reasons already sited.

What if we had spent that $200 million tackling family violence (instead of the current $14 million campaign)? How many children and women’s lives would be saved? How about using that money to insulate and weatherproof state housing? How many children’s lives would that save? How about building and running another starship-type children’s hospital?

As a doctor who works in the resource-constrained environment of a public hospital, I can only abhor the politically motivated waste of $200 million on a failed experiment. Truly a pointless use of a needle…

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