The SMC put the following questions to Professor Diana Lennon, head of Clinical Paediatrics, School of Medicine, at Auckland University, who in a new research paper* claims a delay in progressing the vaccine strategy against menigococcal B, “led to unnecessary and potentially avoidable deaths and sequelae, many lifelong”.
Click here to read a previously published Q&A on the research with Dr Nikki Turner, director of the Immunisation Advisory Centre.
Why was there a “late engagement” by the Ministry of Health (MOH) on the MeNZB vaccine, even though it initiated the 1996 meeting with experts in Baltimore?:
“Chaos might be a polite way of putting it. There was no real understanding that communicable diseases are more easily controlled than most other diseases. Although this was a tricky one that was a unique situation for a small country, there were good signs at the beginning. But there was a lack of leadership, a lack of knowledge, a lack of training — MoH officials were not required to have communicable disease training in their education”.
“There was also a factor of New Zealand thinking it was truly developed, like a surgeon-general in the USA who once famously said `We’ve solved infectious diseases, we’re moving onto something else”. New Zealand did shift its focus to non-communicable diseases, and really ignored the fact that it had low-hanging fruit in a lot of communicable diseases that could be controlled. Big-ticket items include pneumonia in small children where improving housing can reduce the hospitalisations’.
Have we learned from the MeNZB epidemic?
“We learned some good things: the national immunisation register was set up and we learned how to get very high rates in Pacific children, who, in the end are the most disadvantaged, and we’ve got a public now more literate in the usefulness of immunisation. People are seeking vaccination, understanding that it’s going to be good for the health system.
“We’ve pushed up immunisation rates, though we’ve now got poor immunisation rates going back 20 – 30 years. The current measles epidemic is our legacy, and that needs a big push again and we should probably think about a catch-up (vaccination) programme. The epidemic is not going to go away with the current initiative and measles will move on out of Auckland. The (MoH) will look the other way for a while … but measles is so infectious”.
Not enough data was collected at the right time to pin down just how effective was the MeNZB programme?
“A randomised, controlled vaccine trial was decided against — largely on ethical concerns over the people who did not receive vaccine becase it’s such a horrible disease. A case-and-control study of vaccine efficacy was very strongly supported by the University of Auckland group, but the vaccine company and the MoH were very much against it. We started it and the funding was withdrawn after a year. And it was only conducted in Auckland, not nationwide. One has to ask questions about why they were both so keen not to have that approach to the next best standard of proving the vaccine worked. Any other method that was available was flawed.
“You can look at the lines in the graph and say (the epidemic) did go away and say it was probably down to the vaccine, but we can’t go down to the fine detail and see it worked in under-2-year-olds or under 1-year-olds”.
Apart from the implications for NZ, such detail could have added to the knowledge needed to make this kind of vaccine available overseas?
“Interestingly, they’ve used this platform to start off doing new vaccine trials. They’ve basically used the platform to say — there’s a paper about to be published — to say it’s 85 percent effective in infants in New Zealand and they’ve quoted this. It is completely untrue, and the company is one of the authors”.
It does raise a suspicion in a layman’s mind that a lack of transparency was of commercial benefit?
“I couldn’t possibly comment”.
How many deaths could have been avoided through early implementation of vaccinations?
“That can be worked out from the paper: we waited far too long. By the time the contracts were signed, there had been 4195 notified cases, and 185 deaths, about 75 percent of them due to the epidemic strain. Obviously not every one of those was avoidable, but let’s say the vaccine was 80 percent effective, or 70 percent effective to be conservative, so you can work out a number. You wouldn’t start from day 1, because this was clearly quite a complicated scientific programme. Although we ran really fast once we signed the contract, it still took two and a half years to do the trials and get the license”.
Could the nation’s health system and bureaucrats now perform better in similar circumstances?
“The meningococcal C outbreak is being well-responded to, very appropriately. But with the measles epidemic their response is lagging: we haven’t got a high enough rate of vaccination,we haven’t considered catch-ups, we haven’t got the second dose to a high enough level to control outbreaks: we’ve been sitting and waiting for another major outbreak of measles.
“And we’re still struggling to raise the vaccination levels for the whooping cough outbreak, though whooping cough is complicated”.
Why did the MeNZB vaccination rates of Pacific Island and Maori children vary so widely?
“There’s not one-size-fits all. Both groups were disadvantaged in terms of economics and healthcare literacy. A previous programme in South Auckland for rheumatic fever had similar issues, so early-on we told the MoH this required a very special endeavour with Maori — Maori have been stuffed around for 150 years, and they don’t trust anybody, and who would criticise them for that? We needed people at a very high level in Maoridom to take this on board, but we weren’t listened to. We had an enormous struggle. In fact, the initial brochures had blonde kids on them. Maybe the Ministry of Health has changed a bit since then. In the Pacific community we did a lot of work through the churches”.
What are you hoping that this position paper will achieve?
“I wanted to document the delay. We tried very hard to get this epidemic under control. We were going for a decade from 1996, and I think that (delay) was ethically and morally defunct”.
* The research, Reducing Inequalities with Vaccine: New Zealand’s MeNZB Vaccine Initiative to Control an Epidemic, is available to registered journalists in the SMC Resource Library.
– Kent Atkinson