Infusion of advanced vaccines: Medications that change history also present logistical questions

Drug manufacturers have introduced vaccines for meningococcal disease, shingles, pertussis, rotavirus, and cervical cancer, meanwhile even more vaccines are in the development pipeline. While each represents a major step forward for public health, the advances present an assortment of challenges from payment rates for physicians to moral issues for parents.

On top of these challenges of logistics and access, rests the ever-present and growing issue of cost. As new and more expensive vaccines hit the market, the price of public health is being considered in a different light.

"Now we're talking about vaccines that we don't get quite as high a return on," he says. "Now we have to look at costs and benefits in terms of life years saved. The new vaccines have moved the discussion into that category of cost-benefit thinking."

THE COST OF PREVENTION

According to the National Center for Health Statistics' most recent report, issued in 2005, vaccination rates in children age 19 months to 35 months are typically above 80%. Vaccines continue to be a cornerstone of public health, and stakeholders recognize them as such.

"Vaccinations have changed world history," says Joel Ward, MD, professor of pediatrics at the UCLA Center for Vaccine Research. "I don't think you could find anything else in public health that has had as much benefit."

In the developed world, vaccines have tamed diseases such as polio, tuberculosis, tetanus, measles, mumps and diphtheria and spared generations of people from premature death or lifelong debilitation. In recent years, advances in immunology and microbiology have accelerated vaccination development, and scientists are finding more and better ways to protect public health.

The improvements come at a cost, however. For example, drug manufacturer Merck & Co. spent almost 20 years developing Zostavax, a shingles vaccine approved in May. RotaTeq, a rotavirus vaccine approved in February, and Gardasil, a human papillomavirus (HPV) vaccine approved last month, were each a decade in development. Combined, drug trials for the three vaccines involved subjects ranging from six weeks to 99 years old, according to Mary Elizabeth Blake, a Merck spokeswoman.

Those development costs inevitably trickle down to the market. A dose of Zostavax costs $145.35. Each dose of the three-dose RotaTeq vaccine costs $62.50 (for a total of $187.50), while the list price on each dose of the three-dose Gardasil vaccine is $120 (for a total of $360).

While advances in preventive medicine are unquestionably welcome, the high cost of these new vaccines has raised questions about how to cover the unprecedented costs.

For health plans and other payers, the issue becomes two-fold, says Dr. Myers. "They need to think of vaccines like they do any other preventive strategy: How many life years am I saving?" he says. As new vaccines, such as the one for shingles, emerge, they must increasingly recognize quality-of-life benefits as well. "We have the capacity to save an enormous amount of suffering. These are big issues."