Saving a life, or saving money

By Jennifer I. Kimball

Meningococcal meningitis and meningococcal septicemia are the leading cause of death by infectious disease in early childhood. Even with early detection, the disease can kill in as little as four hours. Tragically, the rate of infection from these killers is three to seven times higher in infants than any other age group.

For years, a commitment by policymakers to eliminate the disease in the U.S. has yielded steady gains. But, under the Obama administration, there are concerning signs of a shift from saving lives to saving money. Now, some in the ethics community are questioning whether federal officials will fulfill their pledge to rid us of this disease and protect kids.

Until recently, the Centers for Disease Control and Prevention was unequivocal in its support of protecting infants through vaccines. In 1999, it published a report from the Working Group on Bacterial Diseases that called meningococcal disease “an important condition for which effective interventions are under development and, in a few years, it may well be a candidate for elimination.” Six years later, another analysis conducted by CDC concluded that, compared to the prevailing strategy of vaccinating only adolescents, by adding the vaccination of toddlers and infants we could roughly double the number of cases and deaths prevented over the same period of time. CDC’s statistics showed that 41 percent of cases in infants less than 1 year old are “preventable.”

But in October 2009 the Meningococcal Working Group, part of a CDC advisory body, changed course and considered not recommending a routine infant vaccination. Its rationale: “Although additional cases could be prevented by either an infant or toddler vaccination strategy, they do it at higher cost.”

Especially chilling are indications that federal vaccine decisions are being influenced by human productivity models that assign economic value to each life potentially saved, but without placing any intrinsic value to life itself. Specifically how CDC’s advisory body will determine or apply an infant’s economic value is still unclear. But it is all the more reason to stay vigilant to their process.

Meningococcal vaccine costs $90 to $120 per dose. It has been widely used with adolescents, and will soon be licensed for infants and toddlers. Studies show that infant vaccination would reduce the disease’s societal costs 40 percent.

The charter of the panel advising CDC is supposed to provide guidance on how to reduce the incidence and burden of vaccine-preventable diseases and increase their safe use. So, why are the panelists suddenly talking like economists? It appears that, under the looming directives of Obamacare, they are increasingly focused on containing cost. This is misguided and ethically wrong.

All this ignores fundamental principles of health care economics: beneficence — to do the good that is possible — and nonmaleficence — to avoid harm. Cost reductions should not be achieved by life reductions. We are humans first.

A concerned physician recently offered a striking analogy: Had the Chilean government followed the “ethi-nomic” policy model of our new health care system, the Chilean miners would still be entombed. The cost of saving them would not have been considered proportionate to the loss of productivity they represented.

The CDC’s vaccine advisory panel is set to meet throughout 2011 and will, by a vote, decide the future of infant meningococcal meningitis and septicemia. Let us pray they will decide that elimination should be the goal, along with protecting the most vulnerable.

Jennifer I. Kimball is a bioethicist and fellow at the Culture of Life Foundation, a research institute that deepens public understanding of bioethics and human life.