Health Check: Yes, but what's the cost?

IT WAS a good news story: a new vaccine against meningitis C that should halve deaths from the deadliest infection of childhood. Only a fool would fail to welcome Frank Dobson's announcement on Tuesday of a mass vaccination programme, to start in the autumn.

Only a fool - or a politician. Simon Hughes is no fool but, as Liberal Democrat health spokesman, he was the first to throw a mug of cold water over Mr Dobson's announcement. What did the cost-effectiveness analysis show, he wanted to know. He was asking, in effect, whether the vaccination programme was going to be worth the money. Meningitis C strikes about 1,500 people a year, mainly teenagers and babies, and kills 150 of them. No figures were available yesterday on the cost of the programme, but it is safe to assume it will be tens of millions of pounds. The question is whether more lives might be saved, and more cases of disease prevented, by investing the same sum elsewhere.

Mr Dobson's reply was instructive. He had received reports from health economists and officials and read them, he said, but the decision to go ahead had been his. "As far as I am concerned it was worth doing," he told the Commons.

This reply is puzzling. In the first place, how can Mr Dobson know it is worth doing if, as he claimed, he does not know what the cost will be? The official line is that negotiations about price are still ongoing. But it is inconceivable that the Government would embark on a programme of this scale without having a pretty clear idea of what it will cost.

So why is Mr Dobson shy of sharing this information? What did the reports from health economists and officials say? In his reply to Mr Hughes, he notably did not say that they backed the idea of mass vaccination. The implication was that he and he alone made the decision to go ahead.

That is a politician's job - not to follow cravenly the cold calculations of health economists but to include them in a cool assessment of the hot- blooded world of real people and real lives. Meningitis is greatly feared and a vaccine that can prevent almost half of all cases - caused by the Group C strain - is surely to be welcomed. But the public is ill-served if it is denied the opportunity to compare the cost of the programme with other improvements in health that the same investment might bring.

Co-incidentally, another announcement on Tuesday provided an opportunity to do just this. Researchers in the US disclosed that they had stopped early a trial of a drug for heart failure, because the evidence of its benefit was overwhelming - preventing 30 per cent of premature deaths - and it would have been unethical to continue denying the drug to those receiving a placebo.

The drug, spironolactone, has been in use for 40 years as a treatment for water-retention but its value as a treatment for heart failure had not been recognised until now. It costs pennies and the British Heart Foundation described the implications of the US research as "potentially very exciting".

Meningitis is deadly, and has caused catastrophe for the families affected. But the fear it engenders is disproportionate to the threat. Heart failure affects tens of thousands of people, many of them parents, whose children are left prematurely fatherless and motherless. If the US research findings are confirmed, this drug would be a cheap way of preventing many more family tragedies.

A complex balance of considerations, medical and non-medical, must be taken into account in setting such priorities. Shall we see a campaign to spread the word about the new heart drug on the scale of that we are about to see backing the new meningitis vaccine?

If anyone doubted that health is political, those doubts should have been dispelled this week.