Jane Wells: Meningitis B vaccine—still learning to deal with uncertainty

Another vaccine controversy rears its head, this time meningitis B. The parents of a two year old who died of the disease posted pictures of their desperately ill child online, precipitating a huge response to a petition to the UK Government for all children up to the age of 11 to be vaccinated, which so far has been signed by over 700,000 people. This is the biggest number of responses to an online petition ever, even more than wanted to stop Donald Trump from entering the UK.

Anyone who hears of this must be touched by the terrible loss suffered by these parents and by their courage in publishing these heartbreaking pictures, and sympathise with their wish to do anything they can to prevent this happening to anyone else. The devastating effects of meningitis and its tendency to kill or maim young children make it particularly emotive. The argument appears very simple; if you have a vaccine, why would you choose not to immunise against this terrible disease? Surely cost should be no barrier when the lives of young children are at stake?

Perhaps even more worryingly, the gist of much of the media coverage has been “if a child is immunised, they can’t get meningitis B.” The introduction of the vaccine for infants was commended for saving “thousands of lives.

So we are left wondering, where is the rapid and authoritative response that explains clearly what vaccines can and cannot do? Sarah Wollaston MP has pointed out that policy has to be based on evidence and take cost-effectiveness into account. But so far the Meningitis Research Foundation has been virtually a lone voice highlighting the limited evidence and the fact that the vaccine does not provide complete protection. There are things the public need to know, or to be reminded of.

First of all, no vaccine is completely effective. A hard truth about Meningitis B vaccine is that we don’t know how effective it might be, given that there have been no trials of the schedule currently being implemented. Nevertheless, we probably know more about the success and failure rates of vaccines than we do about many other medical interventions, and that generally there is a balance of benefits over harms for populations, even if individuals might not always benefit (and leaving aside questions of opportunity cost).

So the most important message could be: even if your child has been immunised, they could still get meningitis. This is a difficult message at a time when we are trying to increase vaccine uptake and seem to have finally put the MMR disaster behind us, but there is a wider principle of engaging the public in grown-up discussions about uncertainty. If we are not honest about the fact that all interventions have harms and costs as well as benefits, and not all have benefits for everyone, we will never get to the point of informed discussions with the public about what medicine can and cannot be expected to do.

Competing interests: My spouse is a trustee of the Meningitis Research Foundation and has received research grants from a number of pharmaceutical companies involved in vaccine development.

Jane Wells is an independent consultant in Public Health based in Oxford. Until 2013 she had worked in the NHS for many years, most recently as a director of or consultant in public health in a PCT.