1150 Seventeenth Street, N.W., Washington, D.C. 20036
If you cannot attend, we welcome you to watch the event live on this page.
Vaccinations are conquering infectious disease and putting rates of vaccine-preventable diseases at all-time lows. Today, vaccine coverage rates are high, many new vaccines have recently been introduced, and the United States has reduced social and economic disparities in immunization rates. The United States has entered a new era of disease prevention. Unlike vaccines of the past, which focused on combating diseases that affect large populations, many vaccines under development today are for devastating diseases with high impact but low incidence or societal burden. Now the Centers for Disease Control and Prevention (CDC) is considering elevating the use of cost-effectiveness as a major criterion in the vaccine scheduling process. Since the full benefit of vaccines is often maximized once enough people are vaccinated to prevent further propagation of diseases, some approaches to measuring cost-effectiveness may not apply well to vaccines, especially those targeted to niche but severe diseases. To ensure public health is protected and medical innovation continues, the CDC's process for recommending childhood vaccines needs to evolve. Panelists will comment on the CDC's future with vaccines, drawing from experiences in public health, policy, and industry.
DAVID CURRY, Center for Vaccine Ethics and Policy
ADEL MAHMOUD, M.D., Princeton University
LESLIE NORWALK, Former Acting Administrator, Centers for Medicare and Medicaid Services
MARK PAULY, Wharton School of the University of Pennsylvania
WILLIAM SCHAFFNER, M.D., National Foundation for Infectious Diseases and Vanderbilt University School of Medicine
Question and Answer
WASHINGTON, JUNE 29, 2011--Adopting cost-effectiveness as a major criterion in vaccine scheduling enlarges the bureaucratic process and stifles innovation, a panel of economists, physicians, lawyers, academics, and business leaders concluded Wednesday at AEI. William Schaffner, M.D., of Vanderbilt University trumpeted the many difficulties that have faced the Advisory Committee on Immunization Practices (ACIP) as it has introduced cost-effectiveness into its recommendation process. ACIP members are asked to evaluate economic models with which they have little experience, and the input variables for many models are uncertain. In addition, it is difficult to account for community benefits--the benefits that accrue to others as a result of one person's vaccination--in traditional models. David Curry of the Center for Vaccine Ethics and Policy concurred with Schaffner and added that another problem lies with asking the ACIP to make decisions based on cost-effectiveness when society has not yet decided what the threshold for approval should be. Mark Pauly of the Wharton School of the University of Pennsylvania said his traditional process of modeling cost-effectiveness is the best process available for making cost-effectiveness decisions. Pauly noted, however, that problems may arise in the implementation process as politics and ethical dilemmas will likely come into play, driving the end result away from the economically efficient outcome. Adel Mahmoud, M.D., of Princeton University argued that the ACIP was being asked to do too much and that the scientific and empirical analysis should be divorced from funding in the recommendation process. Leslie Norwalk, former acting administrator for the Centers for Medicare and Medicaid Services during the George W. Bush administration, argued that government actions in recent years have increased uncertainty in the vaccine industry, which could impede innovations in new vaccines.
David R. Curry is the executive director of the Center for Vaccine Ethics and Policy (CVEP), a program of the Center for Bioethics at the University of Pennsylvania; the Wistar Institute Vaccine Center; and the Vaccine Education Center at the Children's Hospital of Philadelphia. CVEP conducts ethics and policy research on global immunization and vaccines, convenes symposia investigating these themes, and provides consultative support for academic, government, nongovernmental organization (NGO), and industry clients. Mr. Curry is also an associate fellow of the Center for Bioethics and a managing principal of davidrcurryAssociates, an independent intellectual services firm with practice areas including ethics and policy framework development, NGO and nonprofit governance and strategy, and knowledge and cultural-asset stewardship. Before forming davidrcurryAssociates, he served as vice president, corporate public affairs, for Unisys Corporation for over two decades. At Unisys, he led a range of corporate functions including issues management, philanthropic and community relations, and special corporate initiatives. Mr. Curry has served on a number of nonprofit boards including those of the Franklin Institute Science Museum, the International Literacy Institute, the Detroit Symphony Orchestra, and the Philadelphia Liberty Medal.
Adel A. F. Mahmoud, M.D., is a professor in the Woodrow Wilson School of Public and International Affairs and the department of molecular biology at Princeton University. He recently retired as president of Merck Vaccines and as a member of the Management Committee of Merck & Company Inc. Dr. Mahmoud's academic pursuits focus on investigating the determinants of infection and disease in human schistosomiasis and other infectious agents. In laboratory and field studies in several endemic areas, he developed the scientific bases of strategies to control helminthic infections that have been adopted globally. At Merck, Dr. Mahmoud led the effort to develop four new vaccines, which were launched in 2005-2006, including a combination of measles, mumps, rubella, and varicella; the rotavirus; shingles; and human papillomavirus. Dr. Mahmoud's leadership in setting strategies for global health shaped the agenda of the Forum on Microbial Threats of the Institute of Medicine in recent years by tackling issues such as biological threats and bioterrorism, SARS, and pandemic flu. He is currently serving as a member of the National Science Advisory Board for Biosecurity and the Committee on Scientific Communications and National Security of the National Academy of Sciences.
Leslie Norwalk is strategic counsel to Epstein Becker & Green PC, EBG Advisors, and National Health Advisors. She serves as an adviser to three private equity firms, Warburg Pincus, Ferrer Freeman & Company, and Enhanced Equity Fund; and sits on the boards of directors of Sound Physicians, Guardian Healthcare Group, Sante Pediatric Rehabilitation, ikaSystems, MTS Medication Technologies, WhiteGlove House Call, Preferred Care Partners, and the Institute for Health Technology Solutions. She is also a member of APCO Worldwide’s International Advisory Council. Ms. Norwalk served the Bush administration as the acting administrator for the Centers for Medicare and Medicaid Services. She managed the day-to-day operations of Medicare, Medicaid, and the State Children’s Health Insurance Program; the survey and certification of health care facilities; and other federal health care initiatives. For four years before that, she was the agency's deputy administrator, responsible for the implementation of the hundreds of changes made under the Medicare Modernization Act, including the Medicare Prescription Drug Benefit. Before serving the Bush administration, she practiced law in the Washington, DC, office of Epstein Becker & Green PC, where she advised clients on various health policy matters. She also served in the first Bush administration in the White House Office of Presidential Personnel and the Office of the US Trade Representative.
Mark V. Pauly is the Bendheim Professor in the Department of Health Care Management; professor of health care management, insurance and risk management, and business and public policy at the Wharton School; codirector of the Roy and Diana Vagelos Life Sciences and Management Program; and professor of economics in the School of Arts and Sciences at the University of Pennsylvania. A former commissioner on the Physician Payment Review Commission, Mr. Pauly has served on the advisory committee to the Agency for Health Care Research and Quality and on the Medicare Technical Advisory Panel. He currently serves on the National Advisory Council for the National Institutes of Health National Center for Research Resources, the National Academy of Sciences' Committee to Study the Veterinary Workforce, and its Committee on the Biomedical Workforce. He has been a consultant to the Congressional Budget Office, the Office of the Secretary of the US Department of Health and Human Services (which supported some of his work on individual health insurance), and health trade associations. Mr. Pauly is a coeditor-in-chief of the International Journal of Health Care Finance and Economics and an associate editor of the Journal of Risk and Uncertainty.
William Schaffner, M.D., is chairman of the Department of Preventive Medicine and a professor of infectious diseases in the Department of Medicine at the Vanderbilt University School of Medicine. His primary interests are infectious diseases and their prevention. He has worked extensively on the effective use of vaccines in both pediatric and adult populations. Dr. Schaffner is a liaison member of the Advisory Committee on Immunization Practices, a former member of the National Vaccine Advisory Committee, and a member of the Physician Advisory Board of the Adult Immunization Initiative of the American College of Physicians. He is also a consultant in public health policy and communicable disease control for numerous institutions, including the Centers for Disease Control and Prevention, the World Health Organization, the Tennessee Department of Health, and the American College of Physicians.
Alex Brill is a research fellow at AEI. A former senior adviser and chief economist to the House Committee on Ways and Means, he also served on the staff of the President's Council of Economic Advisers (CEA). In Congress and at the CEA, Mr. Brill worked on various economic and legislative policy issues, including dividend taxation, the alternative minimum tax, international tax policy, Social Security reform, defined-benefit pension reform, and US trade policy. At AEI, Mr. Brill studies the impact of tax policy in the US economy; the fiscal, economic, and political consequences of stimulus legislation; health care reform, pharmaceutical spending, and unemployment insurance reform; and financial innovation and technology.