The Health technology assessment of a selective BCG vaccination programme: Draft
for public consultation evaluates the clinical- and cost-effectiveness of a proposed
change to the Irish BCG programme, as well as organisational and ethical issues.
Currently, Ireland is one of only two Western European countries with a policy of
universal vaccination against tuberculosis (TB).
HIQA’s Director of Health Technology Assessments, Dr Máirín Ryan said: “The sixweek
public consultation starts a discussion on the future of Ireland’s BCG
vaccination programme. It allows the public to review the Authority’s advice and give
their feedback on a potential change to the BCG vaccination programme.”
BCG vaccination is one of a number of TB-control measures in Ireland. TB control
focuses on protection, prevention and treatment. In the context of a falling incidence
of TB, a shift in emphasis from protection by vaccination to prevention may be
appropriate.
In line with global trends, TB incidence in Ireland has been in decline over the past
25 years. The assessment found that Ireland meets the World Health Organization’s
(WHO’s) criteria for discontinuing universal vaccination. However, unlike other
European countries with a low incidence, Ireland has continued a policy of universal
vaccination.
Dr Ryan continued: “In the context of a fall in TB incidence and diminished risk of
acquiring TB, there has been a shift in the balance between the benefits and risks of
offering vaccination to all infants. Falling TB incidence has decreased the potential
benefit of BCG vaccination for the majority of children. Selective vaccination will
continue to protect those at higher risk while avoiding unnecessary side effects in
those with a limited capacity to benefit from vaccination. The majority of infants
vaccinated incur minor side effects while one in 1,200 infants will incur side effects
that require medical follow up.”
“Neither vaccination programme is cost-effective, but a selective vaccination
strategy would target resources to those who would benefit most. Given the
continued decline in TB incidence, selective vaccination offers a better balance than
universal vaccination in terms of benefits and harms. The TB-control programme
should be optimised prior to any change in the vaccination programme.”
A move from universal to selective vaccination would greatly reduce the number of
vaccinated infants from approximately 61,000 to 8,000 per annum. It would also
significantly reduce the number of children experiencing adverse effects.
Dr Ryan concluded: “Any decision to change the BCG vaccination programme will
require that the public are informed and educated on such a decision. This public
consultation starts the discussion and invites feedback from all interested parties.”
The public consultation will last until October 21, following which the Authority will
publish the findings of the assessment and advise the Minister for Health, Leo
Varadkar.
