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DH advisors backtrack on pneumococcal vaccine withdrawal

Government advisors have performed a u-turn on their recommendation to scrap the ‘ineffective' pneumococcal vaccination of older patients.

A Department of Health advisory committee recommended in March that the universal pneumococcal vaccination programme should be scrapped in patients aged 65 and over, after a review by the Joint Committee on Vaccination and Immunisation concluded it had ‘no discernable impact' on rates of pneumococcal disease.

But new data supplied by the Health Protection Agency has forced the JCVI to issue a new statement urging the DH to retain universal vaccination, as, despite the ‘limited effectiveness' of the vaccine, continuing a universal vaccination programme – often delivered in conjunction with seasonal flu programme – would be cheaper than moving to a general practice-led risk group-based system.

The HPA data suggested the efficacy of the vaccine is around 65% in the first two years after vaccination, and 62% between two and five years after vaccination, but plummets to just 28% more than five years after vaccination.

For invasive pneumococcal disease the HPA analysis suggested vaccination is ‘moderately effective, with an efficacy of 47% in the first two years, 21% between two and five years and just 15% after five years.

But this still means that ‘the vaccine may be more effective than had been assumed previously by the JCVI', according to the committee statement, and they were prepared to recommend the pneumococcal vaccination programme is retained, but ‘kept under review and be reviewed again within two years'.

In a letter to GPs published today, Professor David Salisbury, DH director of immunisation, wrote: ‘Whilst uncertainty remains about the effectiveness of PPV, there is better evidence from the UK experience of the vaccine suggesting that PPV provides some moderate short-term protection to those aged 65 years and older, although protection may be less and wane faster in older age groups and for some clinical risk groups.

‘The findings of the new analyses suggest that the programme remains cost effective, despite the limited effectiveness of the vaccine, and may be more cost effective than implementing a risk group-based programme.'

The minutes from the JCVI's June meeting also reveal the committee has asked the HPA to ‘complete a study on the impact and cost-effectiveness of the seasonal influenza programme', in order to consider possible extensions to the programme.

The JCVI influenza sub-committee will review the analysis at its meeting in September, and present its recommendations to the main JCVI committee at its next meeting in October.


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