Dolinar speaks frequently throughout the United States on the historical, political, and economic aspects of health care. He has testified before the U.S. Senate Subcommittee on Consumer Affairs and has also given Congressional briefings regarding health care issues. He has presented to state legislators, attorneys general, and various industry groups. He is interviewed frequently by local and national media, including CNN, CBS, and PBS.
Dolinar’s articles and opinion pieces have appeared in The Wall Street Journal, USA Today, New York Times, New England Journal of Medicine, JAMA (Journal of the American Medical Association), Health Care News, and Diabetes Research. He is co-author of the book Diabetes 101, now in its third edition.
He is a member of the board of the American Association of Clinical Endocrinologists (AACE) and serves on its National Legislative and Regulatory Committee. He is also the chair of its Future of Health Care Task Force. Dolinar is a member of numerous other professional and civic organizations. In the past he was president of the Arizona Chapter of the Juvenile Diabetes Association.
Dolinar served as a flight surgeon in the Vietnam War and is a retired U.S. Air Force Colonel.
Latest posts by Richard Dolinar (see all)
- The Mystery of Prescription Drug Prices - February 1, 2016
- CDC’s Upcoming Vaccine Decision Has Big Implications - June 15, 2011
Vaccination has been found to be one of the most cost-effective health-care choices. Historically, if a vaccination was approved by the Food and Drug Administration (FDA), the Centers for Disease Control (CDC) would recommend it.
This might change, however, as the Advisory Committee on Immunization Practices (ACIP), a section of the CDC, is considering not recommending that the meningitis vaccine be given to young children even though they constitute more than a third of those who contract the disease. The reason: They say it’s not cost-effective. A scarcely advertised meeting will be held Wednesday [June 15] to discuss this matter. (Go here for more information.)
N. meningitidis has become the leading cause of bacterial meningitis in children and young adults in the United States. Before antibiotics, the mortality of meningococcal infection was 70 to 90 percent. Current mortality rates, now that antibiotics are available, are still high but much improved, at 10 to 14 percent. Death can occur within hours of the onset of the infection because of the collapse of the patient’s vascular system by the endotoxins produced. One in 16 infants who contract the disease will die from it.
Each year there are more deaths from meningococcal disease than there were from mumps, rubella, and rotavirus each — even at their peak annual mortality rates. Infants are vaccinated against all of these, but not meningococcal disease.
The CDC conducted a survey of meningococcal meningitis from 1992 to 1996, estimating about 2,400 cases were occurring annually. Seventeen percent of these cases were occurring in children less than one year of age, and 39 percent were among children below the age of two. Of those children who survived, up to 20 percent had amputations, seizures, learning disabilities, hearing loss, and paralysis. Thus in 1999 meningococcal disease was on the CDC’s priority list of vaccines to be developed.
The vaccine costs approximately $79 to $110 per dosage. This is a pittance amid the approximately $250,000 which the U.S. Department of Agriculture estimates is the cost to raise a child to age 18. And certainly this price pales when compared with the cost of treating this disease when it does occur. Thousands of dollars are needed for the ICU care alone. In fact, many survivors of the disease have hit their $2 million health insurance cap.
These dollar amounts, moreover, don’t account for the immense pain and suffering that families go through when a family member is stricken with this disease, nor do the numbers adequately value the 10 infant deaths which occur in the United States each year from this disease.
It’s ironic that when a drug is on the market, and an increased death rate is noted to occur in those patients on the drug, it is removed and banished from the market. Some drugs have been pulled from the market after allegations of less than 40 deaths. Yet at 10 childhood deaths per year from meningitis, this number will be tied in four years and grow larger as each year passes. If drugs can be pulled from the market for fewer deaths, shouldn’t vaccines be put on the market to stop other preventable deaths?
Through the Vaccines for Children program, the federal government purchases about 55 to 60 percent of the vaccines administered to children. If ACIP does not recommend vaccinating children for this disease, even though it has already been approved by the FDA, the government will not buy it, and the market for this vaccine will suffer a severe blow and possibly collapse. Biotech firms will stop making the vaccine. The drug will then be available to no one. This would also affect future development of new vaccines. If companies cannot profit from the production of new vaccines, they will invest their resources and talent elsewhere.
As Obamacare becomes implemented in the years to come, such decisions based on cost-effectiveness instead of effectiveness will become the norm, and access to health care will shrink considerably. We should be concerned about the CDC’s decision regarding this vaccine as a portent of things to come.