Meningitis B Vaccine

Debate between Jane Ellison and Geoffrey Clifton-Brown

Monday 25th April 2016 Westminster Hall

[Jane Ellison]

I have only had initial conversations with Public Health England about the shape of the campaign, but I can assure my hon. Friend that the officials and the other people working on this campaign will look very carefully at what has been said today, and at some of the ideas that hon. Friends and other Members have put forward, and of course they will take all those points into account.

[Geoffrey Clifton-Brown]

I fear that I am becoming the bane of the Minister’s life over this issue, so I apologise, but I am grateful to her for giving way. One of the issues that I raised in my speech was the unit cost. As I understand it from her reply today, she does not think that there is a case yet for rolling vaccination out to children under five. Would she undertake to keep this matter under review, and would she also undertake to ensure that the JCVI, or Department of Health officials, will continue to have discussions with GlaxoSmithKline on what the drop in the unit cost might be if all these extra vaccinations were given to under-fives?

[Jane Ellison]

I can assure the whole House that the JCVI keeps that under constant review. It is not something that is occasionally dusted off and looked at every four or five years. The committee looks at all the factors that go into making the relevant decisions. When the factors that contribute to its decision making change, it looks into them. I have already given the House the assurance that the JCVI will keep that under careful review. The Select Committees heard directly from Professor Pollard and had that assurance from him. However, I will draw the JCVI’s attention to the concerns raised in this debate and the huge level of interest in the matter in the House and among the wider public.

As came out in the evidence that the JCVI gave to the Health Committee and the Petitions Committee, under the current cost-effectiveness criteria, the men B vaccination programme was only just cost-effective even for infants on JCVI’s final analysis, but we did not shy away from introducing it because we know how devastating meningitis can be and how important protecting children from it is to parents. That is why we became the first country to have a programme of using Bexsero. Many other countries have asked experts to consider men B vaccine programmes, but because the cost-effectiveness is so borderline, to date only Ireland has recommended a programme. I understand that it will start in the autumn, using the same criteria as the UK’s programme. We are leading the way in protecting our children from men B.

As I draw my remarks to a close, I want to reiterate Members’ thanks. I appreciate the fact that so many Members have expressed their thanks to Professor Pollard and the JCVI for the complex and important work that they do. That also goes for the many clinical experts who give us their expertise on which to make these enormously difficult decisions.

Meningitis B Vaccinations

Debate between Jane Ellison and Geoffrey Clifton-Brown

Monday 7th July 2014 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate my hon. Friend the Member for The Cotswolds (Geoffrey Clifton-Brown) on securing this debate on the meningococcal B—or MenB, as I think we will call it—vaccination. It is a hugely important topic to which he has done great justice. Obviously, this is a very topical public health issue. He is not alone in this House in having had constituents who have felt the devastating effects of MenB, and he put his case passionately; I certainly respect that. Of course, we recognise the devastating impact that MenB disease can have, and Members have described it. It is often known among clinicians and parents as a parent’s greatest fear.

Children aged less than five years are most affected by MenB. As my hon. Friend mentioned, the peak of the disease is in infants aged 6 to 12 months. MenB is fatal for about one in 10 of those who develop meningitis and/or septicaemia. With early diagnosis and treatment, most people can make a full recovery, but around a tenth of survivors have major physical or neurological disabilities, including amputation, deafness, epilepsy and learning difficulties, so it is truly devastating. It is, thankfully, relatively uncommon, with an average of about 1,000 cases per year in England and Wales over the last decade. Incidence has been decreasing in recent years, as was alluded to in an intervention, but it is unpredictable and it could rise again quickly. That is why the advent of a vaccine that could provide protection against MenB is so welcome.

If the House will indulge me, I will go over the history of the investigation into the vaccine and the work of the Joint Committee on Vaccination and Immunisation. It is worth noting for the record that the JCVI is an independent departmental expert committee that provides scientific advice to inform policy making. It is a statutory standing advisory committee for England and Wales under the National Health Service Act 1977. It has no statutory basis for providing advice to Ministers in Scotland or Northern Ireland, although Health Departments in those countries may choose to accept the committee’s advice or recommendations, and they generally do.

In anticipation of a MenB vaccine being developed and licensed, the JCVI began work to consider a possible MenB immunisation strategy in 2010. The MenB vaccine Bexsero, manufactured by Novartis, was licensed by the European Medicines Agency in January 2013. The JCVI’s work before that date enabled it to provide advice at the earliest opportunity, so it is not quite right to say that there has been a great delay. The work had begun in anticipation to try to get us ahead of the situation. The JCVI looked to base its recommendations on the best available evidence for efficacy and cost-effectiveness.

Following the licensing of the vaccine, my right hon. Friend, the Secretary of State for Health requested a recommendation from the JCVI on the use of a MenB vaccine under the provisions of the Health Protection (Vaccination) Regulations 2009, which provide the basis for the public’s right of access to national immunisation programmes in the NHS constitution. The Secretary of State has a statutory duty to implement a recommendation from the JCVI on a new immunisation programme, so far as reasonably practicable, where cost-effectiveness has been demonstrated.

The Secretary of State and my predecessor, my hon. Friend the Member for Broxtowe (Anna Soubry), subsequently met to discuss the MenB vaccine with the national meningitis charities Meningitis Now and the Meningitis Research Foundation. Like my hon. Friend the Member for The Cotswolds and other Members in previous debates, I pay tribute to those charities for their excellent work.

The JCVI published an interim position statement on the MenB vaccine for consultation in July 2013 to assist it in making a complete assessment of the available evidence. That interim statement did not recommend a national immunisation programme because of uncertainties about the vaccine’s effectiveness and cost-effectiveness. In response to its consultation, the JCVI received new and recently published evidence on the MenB vaccine. The JCVI also considered comments and queries received in response to its interim position statement. Many of those comments and queries followed similar lines to those raised by my hon. Friend and made the same points on the severity of the impact on children who survive MenB. All the evidence and submissions led to further detailed analysis of the cost-effectiveness of a MenB immunisation programme.

Having considered the outcome of the further analysis at its meeting in February 2014, the JCVI recommended on 21 March that there should be a carefully planned national MenB immunisation programme for infants, starting at the age of two months. The JCVI made it clear that that recommendation was subject to the vaccine being available at a cost-effective price lower than the list price of £75 a dose.

There was some rather inaccurate media reporting when the JCVI’s recommendation was published that suggested that external influences might have led the JCVI to change from the position in its interim statement. The JCVI is an independent committee that greatly values its independence, so I remind Members that, in response to its consultation, the JCVI received new and recently published evidence and relevant comments that led to further analysis and the recommendation that the programme should be cost-effective subject to vaccine price. That is why the JCVI’s position shifted; there was no question of external interference.

[Geoffrey Clifton-Brown]

I am grateful for the way in which my hon. Friend is presenting her reply. From what she has said so far, the only issue seems to be the cost-effectiveness of the vaccine. Will she give any indication of when the cost-effectiveness issue is likely to be resolved so that a roll-out can begin for two-month-old babies, with a catch up for four-month-old babies?

[Jane Ellison]

Rather frustratingly, for me and for my hon. Friend—he alluded to this in his speech—I am not in a position to answer that, because to do so would be to pre-empt the stage we have reached with the issue. What I can say is that this country has world-leading vaccination programmes and a great deal of experience in planning them and rolling them out very effectively. I can assure him that all our experience would be brought to bear in a positive way at that stage. I cannot pre-empt either the timing or the price, but he can be assured of the expertise that sits behind the UK’s vaccination programme.

The Government welcomed and accepted the JCVI’s recommendation and hope that the UK will be the first country in the world to launch a national immunisation programme for MenB. As I have just said, that would continue our successful track record in providing a world-leading national immunisation programme.

I acknowledge that some people might say—I would not blame them—that cost-effectiveness should not be an issue when talking about a vaccine to protect very young children from a potentially fatal disease. However, it is important to consider cost-effectiveness so that money spent on new immunisation programmes does not use finite NHS funds that would otherwise provide more overall benefit to the wider population if spent on other treatments or services. We all recognise that those decisions are not easy, which is why so much expert thought and careful consideration go into them.

My hon. Friend asked when immunisation would start, and I have explained that we are not in a position to comment on that, but we are in a position to draw on great expertise when we face that issue. As I have said, the JCVI recommended that a MenB vaccine be introduced but only at a cost-effective price, below the list price published by Novartis. Therefore, the first essential step is to agree a cost-effective price for the vaccine with the manufacturer. We want to agree that with Novartis as soon as possible so that children can benefit from the vaccine, but we need to ensure NHS funds are used effectively, as I have explained. We must also follow due process on spending approvals within the Government before launching any procurement. That is quite a complex process involving a detailed business case.

We see the onus as being on the manufacturer to respond positively to the JCVI’s recommendation so that we can purchase the vaccine at a price that represents good value for money for the NHS. If we can obtain the vaccine at a cost-effective price, the introduction of the new vaccination programme would need to be carefully planned with the manufacturer and the NHS so that parents can be confident of a sufficient and sustainable supply of vaccine, with arrangements in place in the NHS for it to be provided and for clear information to be given to parents to enable them to make an informed choice.

I hope that it will give my hon. Friend some reassurance to know that last year the NHS introduced three new vaccination programmes and another one was rescheduled, which demonstrates that that is something we can do. That large expansion in the national immunisation programme was unprecedented. We must ensure that the NHS is fully equipped to be able to deliver another programme safely before introducing it. We hope to be able to start the procurement process soon and to purchase the vaccine at a cost-effective price.

My hon. Friend asked about adolescents. The JCVI’s advice was that research was needed on the effectiveness in adolescents of preventing transmission of infection. I am aware of the cases on US campuses to which he alluded. The Department is considering how best to commission the necessary work. If I have any update on that situation, I will write to interested Members after the debate. In addition, I will give an update on where we are in the process as soon as I am in a position to do so. If the procurement is successful, we will be in a position to make firm plans for the introduction of the new MenB immunisation programme. At that point I will be able to say a lot more. I accept that it is frustrating that I cannot say as much as he would like.

I thank my hon. Friend for raising this incredibly important subject. All of us, as constituency MPs, and certainly those of us who are Health Ministers, are extremely aware of the importance that many parents place on this subject and the fear that MenB raises for some many people. He was right to ask me to come to the House and address the subject, even if I cannot do so in quite as much detail as he would like. I look forward to updating the House in due course and will do my very best to ensure that I keep all interested Members fully up to date as we progress with this important process.

Question put and agreed to.