Medicines manufacturers could be forgiven for feeling overlooked by the NHS Long Term Plan, with its clear focus on prevention over pills. Their colleagues in the vaccine industry may in contrast have good reason to be optimistic. Immunisation is a cornerstone of prevention, and NHS England’s ambition is clear: there will be both investment and action to increase vaccination uptake and reduce variation.
The extension of the HPV programme to adolescent boys is a strong positive signal for industry that, where the evidence is clear, investment will follow. The taxpayer funded Vaccines Manufacturing Innovation Centre announced at the end of last year is another welcome beacon to industry, indicating the importance of vaccine manufacturing capacity to UK life sciences policy.
Delve deeper however and there is the potential for impending change in vaccine policy, with mixed implications for the sector.
Vaccines are not immune – pardon the pun – to the pricing pressure being applied the pharmaceutical industry from ever-tightening drugs budgets. While the UK has a world-leading vaccines programme, the JCVI (the industry’s equivalent to NICE) doesn’t shy from making challenging recommendations in its efforts to maximise efficiencies and value for money. Decisions with significant implications for how vaccines are funded are due to be made soon – amongst them whether the QALY threshold for reimbursement of new vaccines should be lowered, raising the bar even higher for new products to market. Vaccines already on the market are also subject to this pressure – as highlighted by the JCVI’s proposal to drop the dosing schedule for routine infant pneumococcal vaccination.
Adding to this general sense of impending change is the “fundamental review” of immunisation standards, funding, and procurement in general practice that will take place in 2019, as announced in the Long Term Plan.
While the aim is ostensibly to improve uptake and reduce variation, it seems likely that this will also consider potential efficiencies and the wider role of the NHS in providing certain vaccinations. Public Health England has already been tasked with reviewing the appropriateness of providing NHS-funded travel vaccines, and a broader review of all NHS-funded vaccinations would feel like a natural extension.
For the travel vaccine industry, scrapping NHS reimbursement would have significant implications. There is of course a risk that travellers deprived of free vaccinations will choose simply not to be immunised, rather than pay for private services. On the other hand, both manufacturers and the private travel clinic industry could stand to benefit significantly from a more level playing field, without competition from the NHS providers able to offer free vaccines as a selling point to attract travellers who then purchase additional, chargeable vaccines.
Elsewhere, any changes to the funding and procurement of GP vaccines could entail significant administrative flux for industry, with potential movement for some vaccines centrally procured by NHS England to direct ordering by practices – and vice versa.
It’s not inconceivable that NHS England may also review its centralised procurement procedures for routine immunisations, with an eye on incentivising best value for tenders.
As is evident, the potential impacts of the review on vaccine manufacturers and the broader supply industry could be substantial, for better or for worse. Questions around the scope of the review remain – prudent action at this stage would be to champion wherever possible the crucial role of vaccines in achieving the Long Term Plan’s ambitions to transform prevention and public health.