UKBSF_vaccines_panel_cropIn this UK Bioscience Forum session, panellists from public health bodies in the UK and industry discussed the changes, successes and challenges involved in childhood vaccinations. Introducing the session, panel chair Dr David Rhodes, Head of Business Development at Public Health England (PHE), highlighted the fundamental role of childhood vaccination in maintaining cost-effective healthcare systems:  vaccinations early on in life help ensure that people remain healthy throughout their lifetime.

The impact of preventable childhood disease was graphically illustrated by Dr Mary Ramsay, Head of Immunisation at PHE and Honorary Senior Lecturer, London School of Hygiene and Tropical Medicine. Grace Williams of the UK was just three years old when she lost both her legs, fingers and several digits as a result of meningococcal infection. Seeing a child suffer in this way, it seems obvious that if a vaccine for children is available, it should be used, said Dr Ramsay.

The NHS Constitution of 2009 reflects this, stating that the NHS is obliged to use a vaccine if one exists. However, vaccination programmes have to be not only effective in protecting children against infectious diseases but also cost effective.

Economic analysis for vaccines is more complicated than for drugs. Unlike drugs, where the therapeutic benefit is delivered quickly to that individual, vaccinations are expected to protect people for several years through indirect, or “herd” protection.

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Dr Mary Ramsay

For example, the meningococcal infection largely affects children under the age of two years. In practice, a combination of vaccinating at-risk young children and teenagers, who have the highest risk of carriage, has shown to be most effective from a clinical and economic perspective, concluded Dr Ramsay.

The UK’s success in delivering childhood vaccination programmes had made it a world leader in providing advice to other countries. Hilary Simons, a Senior Specialist Nurse at the UK-based National Travel Health Network and Centre, NaTHNaC, noted that the organisation’s helpline had 50,000 enquiries over a five-year period and receives two million website hits each year.

From a development perspective, vaccination programmes can be challenging because organisms change. For meningococcal disease, the serum bactericidal assay, the gold standard for assessing protection, is becoming less reliable in the pediatric setting, explained Dr Stephen Taylor, Senior Project Team Leader (Pathogen Immunology) at PHE.

With up 250 different strains of the infection, finding suitable donors with low levels of bactericidal concentrations is challenging. Dr Taylor’s team is pioneering a high throughput surrogate complement deposition assay that uses much smaller serum volumes and an IgG human depleting plasma that overcomes problems of sourcing the human complement.

Attitudes towards vaccine effectiveness among regulators are also changing. For example, GlaxoSmithKline’s malarial vaccine offers 40%-50% protection which can help reduce disease burden, especially because many episodes can occur. Dr Volker Vetter, Global Medical Affairs Lead (Nisseria and Polio) at GSK, Belgium, said that the vaccine may well not have been approved a few years ago based on that level of clinical efficacy. Despite this, Dr Vetter reiterated the primacy of cost-effectiveness in decision making on vaccine use in healthcare systems, echoing the earlier comments of Dr Ramsay and other speakers.