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When the polio vaccine arrived in the 1950s, it cost less than $2 a dose and saved thousands of lives. Today, some vaccines run more than a hundred dollars a dose, while preventing illness in only a few people.
As NPR's Jon Hamilton reports, that has the government debating if some new vaccines are worth the price.
JON HAMILTON: New vaccines are approved by the FDA, but how many people get them depends largely on a group called ACIP, the Advisory Committee on Immunization Practices. Both the government and private insurers use ACIP recommendations to decide which vaccines they'll pay for.
As the cost of vaccines has risen, ACIP members have found themselves spending more and more time on economics. William Schaffner, from Vanderbilt University, says once vaccine that highlights the issue protects against bacteria that can cause meningitis.
Dr. WILLIAM SCHAFFNER (Chairman, Department of Preventive Medicine, Vanderbilt University): If there is an illness that is highly notable and feared by the population, that's it. No parent wants their child to have this illness.
HAMILTON: It tends to attack young people and can kill in a matter of hours. Outbreaks on college campuses have received a lot of media attention. So, back in 2005, ACIP recommended that every adolescent in the U.S. get the vaccine. It costs nearly $100 a dose, which means hundreds of millions of dollars a year paid by the government and private insurers.
But the bacteria infect only a couple of thousand people in the U.S. each year, and that number was going down even before the vaccine arrived.
Schaffner, who is part of an ACIP group that study meningitis, says in this case, vaccination is a very expensive away to save lives. And yet, he says...
Dr. SCHAFFNER: Curiously, the cost-benefit analyses regarding the use of meningococcal vaccine are usually acknowledged but put to the side.
HAMILTON: Not anymore. Late last year, ACIP members gathered in Atlanta to discuss whether to recommend a booster shot. Again and again, committee members and public health officials came back to the cost.
Unidentified Man #1: Is it appropriate to almost double the amount of money spent on this program?
Unidentified Woman #1: One of the drivers of this analysis is the price of the vaccine.
Unidentified Man #2: So the cost per vaccinae(ph) would be $189.
Unidentified Woman #2: Approximate cost of $387 million annually.
HAMILTON: Nearly $400 million to prevent about 23 deaths. Ultimately, ACIP went ahead and recommended the booster, even though it doubled the cost. But Schaffner says that debate reveals how much things have changed at ACIP.
Dr. SCHAFFNER: Back in the day, in the 1980s, cost-effectiveness - indeed, even the cost of vaccines just wasn't discussed. In part because vaccines were so much cheaper then.
HAMILTON: Now, the Centers for Disease Control and Prevention spends more than $3.5 billion a year just on vaccines for children. And in February, at another ACIP meeting, CDC Director Thomas Frieden made it clear that he's frustrated.
Dr. THOMAS (Director, CDC): Most newer products and new formulations of old products have come at substantially higher prices. And we've also seen prices rising after initial federal contracts were set, and prices failing to fall when vaccine schedules are compressed or a second vaccine manufacturer enters the market.
HAMILTON: For their part, manufacturers say most vaccines still aren't very profitable. They also note that when prices were lower, companies stopped developing new vaccines or simply got out of the vaccine business.
So now, Schaffner says, ACIP members find themselves in the difficult position of deciding not just how much good a vaccine can do, but whether it's worth the cost.
Dr. SCHAFFNER: I think it's fair to say it's that aspect of their deliberations with which they're least familiar.
HAMILTON: ACIP meetings now include presentations by experts on cost-effectiveness.
But Mark Pauly, a health economist at the University of Pennsylvania, says that doesn't solve the fundamental problem.
Professor MARK PAULY (Health Economist, University of Pennsylvania): You do have a rough idea that if it's $1.98 per life saved, that sounds like a good thing to do. And if it's $198 million per life saved, that sounds like not a good thing to do. But where to draw the line is the part that any sensible person will run away screaming from trying to answer that question.
HAMILTON: Pauly says federal lawmakers should draw the line, but they don't seem eager to do that. So it may be up to ACIP. And the meningococcal vaccine may be what forces the issue.
In April, the FDA approved a two-dose version for infants and toddlers. That means it will soon be possible to protect even very young children. But the cost could reach a billion dollars a year and ACIP will have to decide whether it's worth it.
Jon Hamilton, NPR News.
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