A common question I’m asked and that I see in forums discussing vaccines relates to how the U.S. recommended childhood immunization schedule compares to other nations, particularly those with similar economics and populations to those of the U.S. Now a new interactive tool at BMJ can help you explore exactly that question.
The multimedia graphic “Calling the Shots” allows you to select individual vaccines or specific countries and lets you explore individual doses, total doses, and the time scale for recommendations for G8 countries. How a country makes decisions about vaccination recommendation is no simple formula. They consider the burden of the disease, both in terms of mortality and in terms of overall suffering and disability, and the cost of that burden compared to the cost of the vaccine. They also consider the effectiveness of the vaccine and its safety profile, including possible side effects. They may also take into account what they expect the uptake of a vaccine to be — a vaccine that’s recommended but which few people actually get may end up being less cost-effective as a result.
Cost is a particularly tricky issue because health care systems differ across different countries. For example, the UK does not routinely recommend the chickenpox (varicella) vaccine as the U.S. does. The reasons for this stem primarily from how the healthcare systems between the two countries differ. Chickenpox can be fatal, but it still kills rarely — about 100 cases a year in the U.S. before the vaccine. That’s no small number for the 100 families who lost someone to the disease, but it is relatively small compared to the scale of the U.S., whose population is considerably larger than that of the UK. In the U.S., where both private insurance companies and federal Medicaid funds pay for the vaccine, the cost-effectiveness calculation and the risk-benefit calculation in terms of illness and side effects both work out in favor of recommending the vaccine. In the UK, the risk-benefit calculation also works out, but the cost-effectiveness one does not. To put it bluntly, simply not enough kids would die from chickenpox every year for the UK government to justify paying for the shot for all its youth.
The above example is one example, but similar calculations must occur for every vaccine considered for a particular country’s schedule. The meningitis B vaccine, for example, is not recommended in the U.S. in part because it’s still a relatively rare disease, but it’s much more common in several countries overseas. The difference in the disease’s incidence will therefore play a role in how the national health agency of that country determines whether the vaccine should be recommended and for whom. Below is an embedded window showing you the page where the tool is hosted (scroll down a little to see the interactive part), but it’s easier to use on the BMJ site.