Experts say public policy must adapt to vaccine innovations

On Wednesday, the American Enterprise Institute held a panel in Washington, D.C., entitled “Recognizing the Promise of Vaccines: Public Policy Must Adapt to New Innovations.”

The event included five panelists - David Curry from the Center for Vaccine Ethics and Policy, Adel Mahmoud of Princeton University, Leslie Norwalk, the former acting administrator of the Centers for Medicare and Medicaid Services, Mark Pauly from the Wharton School of the University of Pennsylvania, and William Schaffner of the National Foundation for Infectious Diseases and the Vanderbilt University School of Medicine.

“The Centers for Disease Control and Prevention is considering elevating the use of cost-effectiveness as a major criterion in the vaccine scheduling process,” the American Enterprise Institute said. “Since the full benefit of vaccines is often maximized once enough people are vaccinated to prevent further propagation of diseases, some approaches to measuring cost-effectiveness may not apply well to vaccines, especially those targeted to niche but severe diseases. To ensure public health is protected and medical innovation continues, the CDC's process for recommending childhood vaccines needs to evolve.”

The panelists commented on the CDC’s future with vaccines, drawing from their experiences in policy, public health and industry. Moderator Alex Brill from AEI said that by mixing those directly involved in healthcare with those involved in the economic aspects of healthcare, they are more likely to come up with an optimal result when it comes to public health than simply using economists alone.

Schaffner and Curry said that asking the Advisory Committee on Immunization Practices members to make decisions on cost effectiveness when they are not familiar with economic models and when society has not yet decided what a threshold for approval should be have led to decision-making difficulties.

The ACIP was being asked to do too much and that scientific and empirical analysis should be divorced from funding in the recommendation process, Mahmoud said.

Norwalk said that government actions in recent years have led to uncertainty in the vaccine industry, which could impede future vaccine innovations.

A traditional process of modeling cost effectiveness is the best process available for making cost effectiveness decisions but that political and ethical dilemmas will likely come into play, Pauly said.