Correspondence

Choices about Meningococcal Vaccination

N Engl J Med 2004; 350:1156March 11, 2004

Article

To the Editor:

The recommendation by Offit and Peter in their Sounding Board article (Dec. 11 issue)1 that clinicians and colleges actively inform parents about the benefits of meningococcal vaccine is a classic example of the “fallacy of the commons.” The fallacy is that individuals can act without consequences to themselves or society. For example, the authors seem to assume that a parent's decision to purchase $80 of vaccine will incur no loss of opportunity to purchase something more valuable, such as a lipid profile. They seem to assume that the effort spent on informing parents of college students about the meningococcal vaccine will not affect the ability to inform them of more pressing issues, such as alcohol abuse. They assume that the time devoted by a student health service to a visit for meningococcal vaccine will not preclude attention to another college student who has a real problem. They also assume that meningococcal vaccination is the only rare risk worthy of such notification (what about tuberculosis or lightning strikes?). Everything we do consumes resources of time, money, effort, and opportunity.

Anthony B. Way, M.D., Ph.D.
Texas Tech University Health Sciences Center, Lubbock, TX 79430-8143
anthony.way@ttuhsc.edu

1 References

1. 1

   Offit PA, Peter G. The meningococcal vaccine -- public policy and individual choices. N Engl J Med 2003;349:2353-2356
   Full Text | Web of Science | Medline

Author/Editor Response

In our article we contrasted the factors involved in establishing public policy with those regarding individual choice, using meningococcal vaccine as the example, but we did not assess the relative risk of meningococcal disease. Although alcohol, motor vehicle accidents, and smoking pose a greater threat than meningococcal disease, both the morbidity and the mortality associated with meningococcal disease and the benefits of immunization remain substantial. Public policy has been established for students entering college, but not for younger children.1,2 To say that a physician should not educate parents about the availability of meningococcal vaccine for adolescents because of limited economic resources is to deny the opportunity for individuals to make informed choices.

Paul A. Offit, M.D.
Children's Hospital of Philadelphia, Philadelphia, PA 19104

Georges Peter, M.D.
Brown University School of Medicine, Providence, RI 02903

2 References

1. 1

   Meningococcal disease and college students: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2000;49:13-20
   Medline

2. 2

   Meningococcal disease prevention and control strategies for practice-based physicians (addendum: recommendation for college students). Pediatrics 2000;106:1500-1504
   CrossRef | Web of Science | Medline