Measles Hearings Offer Counterpoint To Pricing Spotlight: Vaccines Touted As Cost-Effective Solution To Outbreaks

Congressional hearings on the recent outbreaks of measles and other vaccine-preventable diseases offered a positive theme for the industry during the ongoing drug pricing debate.

Recent House and Senate hearings exploring the underlying causes for recent outbreaks of measles and other vaccine-preventable illnesses provided a timely message about the importance of the pharmaceutical industry amid heavy criticism over its drug pricing practices.

The Senate HELP Committee held a hearing March 5 on vaccines and preventable outbreaks, with a panel that included academics, patients and Washington State Secretary of Health John Wiesman. That followed a House Energy and Commerce/Oversight Committee hearing Feb. 27 that focused on the measles outbreak with two government witnesses: National Institute of Allergy & Infectious Diseases Director Anthony Fauci and National Center for Immunization and Respiratory Diseases Director Nancy Messonnier.

While the hearings did not deliver much in the way of news or legislative next steps – or direct praise for drug manufacturers – they did serve as a timely reminder that at least some of what pharmaceutical companies offer society is well worth the price.

The vaccination hearings stayed under the radar relative to the attention on the drug pricing testimony from seven major pharmaceutical executives in the Senate Finance Committee – not to mention the testimony of President Trump’s former attorney Michael Cohen the next day. (Also see "Big Pharma Defuses Drug Pricing Landmines On Capitol Hill " - Pink Sheet, 26 Feb, 2019.)

Still, the two hearings offered positive notes in contrast to most of the themes of the drug pricing debate, emphasizing the efficacy and cost-effectiveness of vaccines.

In the Senate hearing, Ranking Member Patty Murray (D-WA) noted that the measles, mumps and rubella vaccine costs just $20 a dose, compared to the $1 million her home state has spent combatting outbreaks. Later in the hearing, Sen. Elizabeth Warren (D-MA) elicited a similar response in an exchange with Jonathan McCullers, chair of the University of Tennessee Health Science Center. McCullers noted that “for every dollar spent on vaccines, you save $10."

Merck & Co. Inc. manufactures the only available MMR vaccine. While the company itself did not come up by name, testimony from both House and Senate witness panels repeatedly testified to the vaccine’s safety and efficacy, and the importance of being vaccinated.

“This is an incredibly safe vaccine,” CDC’s Messonnier told the House Energy and Commerce Committee. “We have a host of experience with it; the vaccine has been used for a very long time. We in the United States enjoy one of the most robust systems to monitor the safety of vaccines. That is why we can say with confidence that this is a safe vaccine. The most common side effect is a sore arm, which goes away pretty quickly.”

Measles Eradication Possible

The MMR vaccine effectively eliminated measles in the U.S. in 2000. A few years later, however, measles outbreaks were again reported in some states, with the worst outbreak in 2014. The return of measles is attributed to “pockets” of unvaccinated individuals – often a result of personal or religious beliefs – that cause herd immunity to fall below critical thresholds.

NIAID’s Fauci noted that the chance of fully eradicate measles is high through vaccine use, especially given that a similar virus found in animals has been eradicated, cutting off any animal-to-human transmission. “I consider it an irony that you have one of the more contagious viruses known to man, juxtaposed against one of the most effective vaccines that we have, and yet we have not been able to eradicate this virus."

The committees called their hearings in response to 206 measles cases reported as of February 28 in 11 states: California, Colorado, Connecticut, Georgia, Illinois, Kentucky, New Jersey, New York, Oregon, Texas and Washington, according to the Centers for Disease Control and Prevention website. Should that rate of infection continue, it will quickly outpace the 372 cases reported in 2018 – and perhaps approach the 2014 spike of 667 cases.

“Measles is one of the most contagious pathogens that confront mankind,” NIAID’s Fauci stressed during the House E&C hearing. An unvaccinated person exposed to someone infected with measles who is coughing and sneezing has a 90% chance contracting the disease, he said. By comparison, while the infection risk for the influenza is high, “it’s nothing approaching 90%."

In one illustration as to how quickly measles can spread, Energy and Commerce Oversight Chair Diana DeGette (D-Colo.) noted that between the time the committee announced the oversight hearing on February 14  and the hearing itself (13 days), 58 additional cases of measles had been reported in the U.S.

The experts testifying at the Senate hearing called for a national campaign to promote the efficacy and safety of vaccines and combat misinformation about vaccine links to autism and other diseases. Some, including the Washington State Secretary of Health, also pointed to the effectiveness of efforts to remove vaccine exemptions at the state level.

“The choice to make exemptions more difficult to get – to make it burdensome to not get the vaccine – is important,” Wiesman said. The Washington State legislature is considering two bills that would remove the personal or philosophical exemption for vaccines for school and child care entry. He also noted that 8% of children in Washington state are out of compliance with school records.

Outgoing FDA Commissioner Scott Gottlieb expressed concern during a March 6 event sponsored by The Hill that state laws moving in the other direction – broadening exemptions for vaccination – could spark a debate over state rights. Despite that, he implored states to “fix the problem” or risk having the federal government step in. (Also see "Gottlieb Worries Vaccine Policy Could Spark Federalism Debate" - Pink Sheet, 7 Mar, 2019.)

During the Energy & Commerce Oversight hearing, DeGette underscored the importance of disseminating accurate information about vaccines. “We have to provide parents and community leaders with real, science-based information not only about how vaccines are safe, but why they are so important,” she said. “We need to support additional research into vaccine safety to further increase consumer confidence in these vaccines."

Sen. Rand Voices Outlier Position

The one outlier in either committee was Sen. Rand Paul (R-KY). While Paul expressed his support of vaccines during the HELP hearing and said that he and his family have been vaccinated, he pushed back against state mandates. Paul’s comments serve as a reminder that some key legislators (and the President) have limits to their vaccine advocacy.

Paul did not ask questions of the witnesses, but rather read a verbal statement that began with a historical account of the smallpox vaccine, noting the death rates associated with a live virus vaccine. He then moved to making a case against mandates: “many governments have taken to mandating a whole host of vaccines, including vaccines for non-lethal diseases."

In some cases, these vaccine mandates have “run amok,” Paul said, pointing to the discontinuation of the rotavirus vaccine RotaShield in 1999 after it was found to cause intestinal blockage in children. FDA has since licensed two other rotavirus vaccines: Merck’s RotaTeq and GlaxoSmithKline PLC’s Rotarix.

“Proponents of mandatory government vaccination argue that parents who refuse to vaccinate their children risk spreading these diseases to the immuno-compromised communities,” he said. “There doesn’t seem to be enough evidence of this happening to be recorded as a statistic, but it could happen. But if the fear of this is valid … we will be next mandating flu vaccines?"

Science only allows for “educated guessing” when it comes to developing a vaccine against influenza, Paul continued. Five states already mandate flu vaccines, but “is it really appropriate to mandate a vaccine that more often than not vaccinates for the wrong flu strain?” His comments elicited enthusiastic applause from anti-vax proponents in the audience.