By Matthew M. Davis, M.D., MAPP
E-mail: mattdav@umich.edu

Objectives: We examined recent public-sector trends in childhood vaccine costs and estimated future costs.

Methods: We used public-sector price data to calculate vaccine purchase cost per child for children aged 0 to 6 years from 1975 to 2001. We fit a linear regression model to historical data and then used it to project costs per child from 2002 to 2020, adjusted to 2001 U.S. dollars.

Results: Controlling for inflation, the cost of vaccine purchase per child climbed from $10 in 1975 to $385 in 2001. The cost of vaccine purchase in the year 2020 following recommendation of 7 additional vaccines is estimated to be $1,225 per child (95 percent confidence interval = $891, $1559).

Conclusions: The cost per child for recommended vaccines at public-sector prices may triple over the next two decades. These projections have implications for vaccine financing at federal and state levels.

American Journal of Public Health December 2002;92(12):1982-7

Testimony by Jerri Johnson

Health and Human Services Policy Committee
January 27, 2003

Childcare providers enforce immunization requirements, state licensers of childcare providers, and the public schools. This enforcement costs money for staff to do record keeping and follow-up. Much of this cost is borne by the state. A study in 1998 estimated that enforcing the immunization requirements cost the state at that time around $5 million per year.

Will adding new vaccines to the list increase costs to schools? It will, because many more follow-up contacts will be needed for these particular vaccines.
Currently, 35 percent of parents are not vaccinating their children for chickenpox. Minneapolis Public Schools estimated that each parent follow-up contact cost $18 in staff time.

Minneapolis Public Schools wrote to the Department of Health asking that no immunization requirements be added until funding is in place to enforce them. In addition to the state costs of enforcing vaccine requirements, these vaccines cost money in health care dollars.

I have included a handout in your package with medical cost analyses of pneumococcal and chickenpox vaccines. Chickenpox and pneumococcal vaccine programs actually cost more money than they save from preventing disease. The pneumococcal vaccine, for example, costs around $60 per dose, or $240 per child for the four-dose series. The chickenpox vaccine also does not recover costs when looking at the cost of the vaccine compared to the cost of the disease. Only by factoring in indirect costs, such as lost wages for a parent to stay home with a child sick with chickenpox, is this vaccine deemed to be cost-effective.

But these assessments of indirect costs did not include the cost of caring for vaccine-injured children. Hospitalization and medical costs for these children are extremely high. During school years, they require special education services, costs borne by the state. These children may later be cared for in group homes the rest of their lives, incurring huge costs to the state. Twelve percent of our children now have chronic disease of some sort, and many medical experts believe that the rapid increase in diseases such as autism, ADD, juvenile diabetes and asthma is partially attributable to the increase in required vaccines.

A parent who stays home for five days when her child has chickenpox may use vacation days or may lose some income. But parents of children disabled by vaccines often must quit work permanently to stay home with their child, losing years of income, and the vaccine-injured child may never grow up to earn a productive income.

But ultimately, the question before us is not about dollars and cents. When we are preventing communicable disease, and when we are preventing vaccine injuries, the real issue is the value in human life that can't be quantified. You can't put a price on the joy of having a healthy baby, and you can't quantify the grief of a parent who loses a baby, no matter what the cause.

And so the Minnesota Natural Health Coalition is calling for the following:

1. Safer vaccines. Pharmaceutical companies need to be held accountable to produce vaccines that have fewer serious side effects.

2. The State of Minnesota should not require new vaccines if we do not know whether they are safe for our children. In the case of the pneumococcal vaccine, during the pre-licensure study where 17,000 healthy infants with no acute or underlying chronic disease were given Prevnar, 162 infants required emergency room care, 24 were hospitalized within 72 hours of receiving the vaccine and eight infants who had never had seizures before had seizures within 72 hours. Forty infants who had never had asthma before required doctor's care for asthma, wheezing, shortness of breath or breath-holding within 72 hours of the vaccine.

One previously healthy child developed congestive heart failure within 72 hours of the vaccine and three children developed hypotonic/hyporesponsive episodes. Were these serious situations caused by the vaccine? There is no way to determine this without following the time-honored scientific process of comparing the test group with a control group that did not receive a vaccine. This was not done. One variable, the test vaccine, was compared with another variable, another experimental vaccine.

Yet the physicians who conducted the study concluded at the end, this test "did not reveal any severe adverse events related to vaccination that resulted in hospitalization, emergency room visits or clinic visits." The Vaccine Information Sheet on Prevnar given to parents at their clinics says, "So far, no serious reactions have been associated with this vaccine." Given the structure of the clinical study, it is not scientifically possible to say that these reactions were caused by the vaccine, nor is it possible to say that they were not.

3. If it is inherently impossible to produce a vaccine without a significant risk of serious adverse effects or death, then we need to be clear about that. If the pneumococcal vaccine effectively reduces pneumococcal disease, but at the price of death or disability to a few babies, we need to know those numbers. Our research needs to be science-based, with control groups, and parents need to know the risks so they can make an informed decision.

We are having a good debate in this country on the smallpox vaccine. This could be a great model for our infant vaccination programs. Public health officials are doing a good job of articulating the risks of smallpox and the risks of the vaccine. One or two deaths per million from the vaccine is being taken very seriously. Adults are weighing the risks and benefits. We should afford the same courtesy to infants and their parents in the routine vaccine program.

4. Parents should be educated that if their child is ill, vaccination should be postponed. They should be told that if their child suffered a seizure or bad reaction to a previous vaccine, she is at risk for an even greater reaction to the next one. If parents have a family history of a severe vaccine reaction, they should know that their child might be at risk.

The CDC already has guidelines on this, and they are printed on the sheets given to parents when the child receives a vaccine. If parents knew this before making their appointments with the doctor, perhaps many vaccine injuries could be avoided. Again, the smallpox discussion is a good model on this--people are being informed that if you have eczema, you are at risk from the vaccine; if you are on corticosteroids you are at risk. Similarly, parents of infants could be advised on this at an early date.

5. If new vaccines being produced cannot be safer, then perhaps we need to rethink the model that vaccinates the entire population for a disease. This model was developed in response to overwhelming epidemics like polio. However, in the case of invasive pneumococcal disease, which affects only 0.2 percent of Minnesota children, this may not be an appropriate model.

6. Finally, parents who believe that their child was harmed or killed by a vaccine need to be heard and taken seriously. They should not be brushed off by being told it was not related to the vaccine. Their experience should be studied for clues to how we can have safer vaccine programs.