When we are immunized, we usually have to get several shots, or doses, before we’re protected against a disease.
Nearly all vaccine-preventable diseases require more than one dose of vaccine to provide us with a strong immune response. It’s not fun, but it’s better than fighting all those infections.
Last summer, an article in Pediatrics described a study which looked at the cost-effectiveness of removing a primary dose of 13-valent pneumococcal conjugate vaccine (PCV13).
This vaccine helps to prevent pneumococcal infections, which can mean anything from an ear infection to pneumonia to meningitis. It can be a dangerous and deadly infection.
Right now, this vaccine is a four-dose series. The first three doses are primary doses, and the fourth dose is a booster.
A primary dose “primes” the immune system, allowing our bodies to develop stronger immunity with each primary dose we receive. The booster dose is the last shove to get us over the top, helping our bodies to develop long-lasting immunity against a particular disease.
The study in Pediatrics was the topic of conversation at PKIDs for several weeks, and, while we were surprised that removing a dose was up for consideration (and you’ll see why in a minute), we thought it was probably more of an intellectual exercise than a course of action that our public health leaders in the US would take.
After all, our tradition in the US is to use all of the tools we have to protect our citizens and prevent infections.
Come to find out, this is more than an exercise in “what if.”
In February, I attended the Advisory Committee on Immunization Practices (ACIP) meeting in Atlanta.
(As noted on their website, the ACIP “is a group of medical and public health experts that develops recommendations on how to use vaccines to control diseases in the United States. The recommendations stand as public health advice that will lead to a reduction in the incidence of vaccine preventable diseases and an increase in the safe use of vaccines and related biological products.”)
Based on that meeting, it sounds like they’re looking at removing a primary dose as a real option.
This may give us an opportunity to save money—$400 to $500 million—but it’s not a risk-free deal. In order to save that money, we have to be willing to see harm come to a lot of people.
This flies in the face of what we, as health advocates, say every day to the folks we meet, which is: Get immunized! Use the safe and effective prevention tools available to protect yourself and your family from unnecessary infections.
It’s easier to make this kind of money-saving decision if the conversation is all about the numbers: the dollar amount saved, the numbers of increased cases of disease, the numbers of hospitalizations and deaths.
Numbers are easy to talk about because they’re not personal.
But this decision to remove a primary dose of vaccine is personal. The consequences will be felt by our people, our loved ones, our friends, and our neighbors. We can’t dehumanize this process by just talking about the numbers.
If the third primary dose is removed, an average of 2.5 more people will die each year. Who are those people? One could be my niece, Millie, who’s just learning to crawl. Another could be your grandson, who loves cheerios and bananas.
Forty-four more people will get invasive pneumococcal disease. My daughter could get meningitis, and your son could get a bloodstream infection.
Fifteen hundred more people will be hospitalized for pneumonia. When my oldest was a toddler, she was hospitalized for pneumonia. It’s a terrifying experience and one that I would not have anyone else go through, if possible.
An additional 10,000 of our friends and neighbors and loved ones will have to be treated for pneumonia as outpatients.
Twenty-three hundred more ear tubes will have to be inserted into the tiny ears of children that we know.
A staggering 261,000 more children will get earaches, fevers, and possibly ruptured eardrums.
All of this happens if we decide to save money and remove a primary dose of PCV13.
It’s all about the numbers. We just have to decide which numbers are more important to us as a nation—the dollar amounts or our people?
by Trish Parnell