Does the ACIP do a cost/benefit analysis for each recommendation?
No. Sometimes a manufacturer will present some risk/benefit information, but the ACIP does not weigh costs and benefits in any systematic way. For example, in Feb. 1998, the ACIP approved a recommendation for a rotavirus vaccine even though the vaccine was not yet on the market and the manufacturer had not yet set a price on it. Obviously, no cost/benefit analysis could have even included the price of the vaccine. Dr. Glode asked about the procedural issues. Should the Committee establish a standard that precludes recommendations without knowledge of vaccine costs? Dr. Orenstein argued that ACIP decisions are based on public health and that holding vaccines hostage to price is a mistake. Cost decisions are negotiated later; data are always incomplete, and costs change. Dr. Helms agreed that the Committee’s job is to decide on what is best for children. The universality argument is compelling; a decision need not rest on cost. Dr. Guerra also felt strongly that the levels of morbidity a
