health council of the netherlands more than 100 years of scientific advice on public health issues

Health Council of the Netherlands

More than 100 years of scientific advice on public health issues

Growth of NVP in the Netherlands

2003Hepatitis B – children at risk

2006Pneumococcal disease

2002Meningococcal C infections

1993Haemophilus influenzae type b

1989Hepatitis B – mother HBsAg+

1974Rubella

1987Mumps

1976Measles

1957Polio

1957Tetanus

1957Pertussis

1957Diphtheria

National Vaccination Programme(10-2006,*mother HBsAg+, &population at risk)

MMRdTP9

Influenza (yearly)>65

aPdTP4 years

MMRMenC14

PnDaPTPHib (HepB*&)11




HepB*0 months

Injection 2Injection 1Age

Organization of NVP in the Netherlands

Linkage to population register Embedded in neonatal care and infant welfare Voluntariness Recalls, outreaching activities High quality information and health education Continuous education of infant welfare workers

Organization of NVP in the Netherlands

National Institute of Public Health (RIVM)– Runs the programme, information, evaluation of

effectiveness, adverse effects

Netherlands Vaccine Institute (NVI)– Produces or buys the vaccines

Health Council (Gezondheidsraad, GR)– Independent, scientific advice

Vaccination coverage, Netherlands(Source: RIVM)

Committees of the Health Council

Independent Based on scientific state-of-the-art Multidisciplinary, including ethical and legal

aspects Personal membership, not representing

organizations Disclosure Deliberations confidential, reports publicized Advisors from RIVM, Inspectorate, Ministry Hearings for social organizations, industry

Request for advice from the Minister of Health in response to report of National Institute of Public Health (RIVM, 2000) Need for new vaccinations in the NVP? Choice of specific (combinations of) vaccines with

respect to side effects? Starting points and assumptions used for cost-utility

analysis? Number of injections that can be administered at one

visit (acceptability in the population)? Total number of vaccinations that can be safely

given, risk of overburdening the immune system? Possibility or desirability to stop certain vaccinations

now in the NVP?

NVP Review Committee

Composition of NVP– Criteria for inclusion– Prioritization

Risk perception and risk communication, health education

Vaccination and maturation of the immune system (Th1/Th2; innate immune system)

Recent reports on NVP

Universal vaccination against hepatitis B (2001)

Programmatic vaccination of adults (2001) Universal vaccination against meningococcal

serogroup C and pneumococcal disease (2001) Vaccination of children against

hepatitis B (HBsAg+ mothers) (2003) Immunisation against tetanus (2003) Yearly reports on adverse events Pertussis (1997, 2000 and 2004) Pneumococcal vaccination (2005)

Purpose of NVP

To protect the population and societal life against serious infectious diseases through vaccination

Subtargets:

1. To eradicate or eliminate a certain disease

2. To reach and maintain herd immunity

3. To protect as many individuals as possible

Emphasis on children in current NVP

1. Children’s diseases are the diseases against which good immunity, also through vaccination, is possible

2. A NVP targeted at children offers the best chances of establishing a high vaccination coverage. A high coverage is important for establishing herd immunity

NVP is becoming a programme for infectious disease control at all ages

1. Children’s diseases become diseases of adolescents and adults (pertussis)

1. Long-term protection? (diphtheria, tetanus)

1. Vaccination in the elderly (influenza, zoster)

1. Vaccination against STD (HPV)

Criteria for inclusion of a vaccination in a public vaccination programme

Disease burden

1. The infectious disease is serious for individuals and affects a sizeable group

Effectiveness

1. Vaccination is effective in preventing disease or reducing symptoms

2. Adverse effects do not detract from the favourable health effects in considerable measure

Criteria for inclusion of a vaccination in a public vaccination programme

Acceptability

1. The inconveniences of vaccination bear a proper proportion to the health effects to be gained

2. The inconveniences of the vaccination programme as a whole bear a proper proportion to the health effects to be gained

Efficiency

1. The cost-effectiveness ratio is favourable to other means of prevention

Urgency

1. Vaccination serves a (potentially) urgent public health problem

Example: vaccination against chickenpox in the Netherlands?

Mostly seen as innocent, but 200 hospital admissions and 2.3 deaths/yr

Vaccination aimed at all children Goal is to prevent complications Vaccines available: separate (one dose), MMRV

(two doses) Linkage of epidemiology of chickenpox and

shingles

Assessment of vaccination against chickenpox, Netherlands (ongoing)

1. Is c. serious for individuals and does it affect a sizeable group?

1. C. affects almost whole year classes, but is only rarely serious. Peaks at a relatively young age and incidence of complications relatively low compared to neighbouring countries. Incidence of complications could be underestimated in hospital discharge data.


1. Is vaccination effective in preventing disease or reducing symptoms?

2. Do adverse effects detract from the favourable health effects in considerable measure?

1. Yes, VE about 90% in studies abroad

1. Possibly: effects on shingles unclear, incidence might rise


1. Do inconveniences of vaccination bear a proper proportion to the health effects to be gained?

1. Do inconveniences of the vaccination programme as a whole bear a proper proportion to the health effects to be gained?

1. Not certain: inconveniences of one or two dose vaccination are limited, but health effects to gained probably as well

1. Not certain: inconveniences of extra jab are limited, but health effects to gained probably as well


1. Is the cost-effectiveness ratio favourable to other means of prevention (or no prevention)?

1. Does vaccination serve a (potentially) urgent public health problem?

1. Not certain: most of the benefits are less loss of productivity of the parents

1. C. is a mostly innocent disease; it is uncertain how vaccination will encroach upon the dynamic equilibrium with shingles; most parents don’t see a need for vaccination


Assess underreporting of complications of chickenpox

Possible influence on incidence of shingles will not become clear in short term

Rather vaccinate against shingles?

Reconsider vaccination against chickenpox for inclusion in NVP when new data on incidence of complications become available

The NVP put to the test

All 15 current vaccinations meet the 7 criteria

Of 23 candidate vaccinations:

– No unqualified recommendationfor extension of NVP right now

– Reconsider within 2-3 yrs: shingles, chickenpox, rota, meningB, hepatitis B (all children), influenza (children, 50-65 yrs), HPV, RSV, CMV (hepatitis A?)

Topics of future advisory reports

Future of the National Vaccination Programme

BCG vaccination

Influenza: children <2 yrs, 50-65 yrs, risk groups

Hepatitis B vaccination (adolescents)Protection of young infants against pertussis

Longer term NVP prospects

Statutory task

"… to advise the government and the parliament on the current level of knowledge

with respect to public health issues ..."

Health Act 1956, 1997

Present day fields

Health care

MTA

Preven-tive

medi-cineEnvi-

ron-mental health

Eco-toxi-

cology

Occu-pational health

Food & Nutri-tion

Advisory Council on

Health Research

(RGO)MTA

Preven-tive

medi-cineEnvi-

ron-mental health

Eco-toxi-

cology

Occu-pational health

Food & Nutri-tion

Health care

Structure

PresidentVice-presidents (2)

Members~ 200

Standing committees (9):

ReviewWork programme





Autonomous ad hoc committees

(~40):Advisory reports





Secretariat:Exec. Director

~35 scientific staff~35 adm. staff

health council of the netherlands more than 100 years of scientific advice on public health issues

Documents