Policy debate needed to ensure Australia remains a global leader in public access to life saving vaccines

Australia’s National Immunisation Program (NIP) is one of the world’s best, achieving some of the highest vaccination rates in the world and supporting community protection against a wide range of vaccine preventable diseases. However, Australia’s timely access to life saving vaccines is under increasing challenge, as the system that assesses which vaccines are included on the NIP falls behind other countries on some issues and may not always match with how the community values prevention.

“There are examples of clinically recommended vaccines that have been delayed or not been listed on the free ‘national’ scheme for various reasons, meaning these vaccines are only available through state or territory-based programs, or private prescription,” said Professor Terry Nolan AO FAHMS, Head of Melbourne School of Population and Global Health at the University of Melbourne. “This situation shines a light on the current mechanisms for measuring the value of preventative vaccines and the need for an informed debate on what updates might be required to maintain Australia’s leadership position.”

Today, at The Economics of Prevention event hosted by the Committee for Economic Development of Australia (CEDA), GSK launched a policy paper entitled ‘The Value of Vaccines – ensuring Australia keeps pace with community values and international practice’. The policy paper highlights current challenges to how prevention and vaccines are valued in Australia and identifies areas in the current process that could be updated to better align with international practice and community values.

GSK Vaccines Medical Director, Dr Bishoy Rizkalla said, “We have a system that was originally designed to assess the cost-effectiveness of therapeutic medicines, with vaccines only being added after the system was established. It is now becoming increasingly clear that this system has challenges in assessing the full value of preventative interventions such as vaccines.”

“Like all good policy in a changing global environment, continuous improvement and refinement is essential to maintain best practice in the service of public good,” added Professor Nolan. “In Australia, we need debate on how prevention and vaccines are valued, and this must include government, industry, technical experts, clinicians, and most importantly, consumers.”

GSK’s policy paper highlights three critical areas for discussion and debate:

1. the narrow healthcare system perspective typically adopted in assessments, which limits the scope of review to only the benefits and costs relevant to the individual/ patient and to the healthcare system. This approach disregards the broad societal impact of immunisation which occurs outside the scope of the healthcare system—for example, benefits to families and carers and benefits to other areas of government expenditure such as the disability and welfare systems;
2. the discount rate applied to future costs and benefits, which is high by international comparison and has the impact of making preventative interventions like vaccines (which often take time for benefits to accrue) appear less cost-effective as compared to therapeutic medicines (which are more likely to provide benefits soon after initiation);
3. the lower cost-effectiveness threshold (willingness to pay per unit of health gained) applied for preventative interventions like vaccines as compared to therapeutic medicines, which has the impact of applying a lower willingness to pay for lives saved through prevention as compared to treatment and thereby disadvantaging vaccines.

Experts are currently able to consider lower discount rates, a broader perspective and the same willingness to pay thresholds across prevention programs and medicines—however, there appears to be a reluctance to do so in base-case assessments. This is inconsistent with international practice and creates a higher hurdle for adoption of prevention programs in Australia.

This paper recommends three updates to current practice to address the three critical areas highlighted, all of which are immediately actionable and none of which require amendment to legislation or change to current institutions:

1. Taking a broader perspective, accounting for costs and benefits outside the health system: The full value of new vaccination programs can only be appropriately accounted for if evidence of broader outcomes is considered. At a minimum this should include the impact disease prevention has on carers, families and the disability system where evidence is available.
2. Applying lower discount rates: Because future health benefits from vaccines are heavily discounted compared to other countries, it means they are considered to be worth less than immediate health benefits (from new therapeutic medicines, for example). Adopting a lower discount rate, in line with international practice, will place greater value on lives, long-term morbidity and costs saved through prevention of disease.
3. Removing the disadvantage applied to new prevention programs and apply the same ‘willingness to pay’ for lives and morbidity saved by prevention and therapeutic medicines.

Professor Terry Nolan has served previously on GSK scientific advisory boards for which compensation was not received. He has been an investigator in vaccine clinical trials sponsored by GSK for which funding was provided to Murdoch Children’s Research Institute. No compensation was provided to Professor Nolan in relation to this GSK media announcement, the value of vaccines policy paper, its associated launch event and related communication activities, and the opinions expressed in the Foreword in the Value of Vaccines policy paper are his own.

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