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Source: Pharmac

What we’re doing

We’re pleased to announce a decision to widen access to funded meningococcal ACWY vaccine (Menactra) for people aged 13 to 25 years in close-living situations, from 1 December 2019.

In summary, vaccination will be funded for people aged from 13 to 25 years living in boarding school hostels, tertiary education halls of residence, military barracks or prisons. After the first year, funding will only be available to people entering their first year of living in such institutions.

We estimate that approximately 35,000 people would be eligible for vaccination during the first-year and approximately 8,000 people in each following year.

This decision will provide vaccination to adolescents and young adults in close-living situations, reducing the carriage of meningococcal bacteria and the risk of these people developing meningococcal disease due to the A, C, W and Y groups. This vaccine does not provide protection against meningococcal group B disease.


Any changes to the original proposal?

This decision was subject to a consultation letter dated 1 September 2019.

The proposal was approved as consulted on except for some changes to the eligibility criteria to clarify that people entering board school hostels, tertiary education halls of residence, military barracks or prisons within the next 3 months would be eligible for vaccination before they enter these institutions.

We received supportive feedback regarding this proposal. We really appreciate the thoughtful feedback and want to thank everyone who responded. We also received feedback requesting further widening of access of meningococcal vaccines. Our clinical advisors have recommended funding for a range of different patient groups and these remain under active consideration by PHARMAC for future funding. 

Who we think will be most interested

  • People who live in institutional close-living situations
  • Doctors in general practice, other primary care prescribers, nurses and vaccinators
  • Secondary schools with boarding facilities, universities and other tertiary educational institutions, student health services
  • DHBs
  • Department of Corrections prisons
  • New Zealand Defence Force and military health services
  • Suppliers and wholesalers
  • Organisations with an interest in immunisation

Details about this decision

From 1 December 2019, access will be widened to meningococcal ACWY vaccine in Section I and Part II of Section H of the Pharmaceutical Schedule for people aged from 13 to 25 years who are living in institutional close-living situations, namely boarding school hostels, tertiary education halls of residence, military barracks and prisons. 

After the first year, funding will only be available to people entering their first year of living in such institutions.

A confidential net price will continue to apply to Menactra. 

The eligibility criteria for meningococcal ACWY vaccine (Menactra) will be amended in Section I and Part II of Section H of the Pharmaceutical Schedule as follows (additions in bold):

Section I

Either:

1.      Any of the following:

  1. Up to three doses and a booster every five years for patients pre- and post splenectomy and for patients with functional or anatomic asplenia, HIV, complement deficiency (acquired or inherited), or pre or post solid organ transplant; or
  2. One dose for close contacts of meningococcal cases; or
  3. A maximum of two doses for bone marrow transplant patients; or
  4. A maximum of two doses for patients following immunosuppression*; or

2.      Both: 

  1. Person is aged between 13 and 25 years, inclusive; and
  2. Either:
    1. One dose for individuals who are entering within the next three months, or in their first year of living in boarding school hostels, tertiary education halls of residence, military barracks, or prisons; or
    2. One dose for individuals who are currently living in boarding school hostels, tertiary education halls of residence, military barracks, or prisons, from 1 December 2019 to 30 November 2020.

Note: children under seven years of age require two doses 8 weeks apart, a booster dose three years after the primary series and then five yearly.

*Immunosuppression due to steroid or other immunosuppressive therapy must be for a period of greater than 28 days.


Section H

Restricted

Initiation

Either:

1.      Any of the following:

  1. Up to three doses and a booster every five years for patients pre- and post splenectomy and for patients with functional or anatomic asplenia, HIV, complement deficiency (acquired or inherited), or pre or post solid organ transplant; or
  2. One dose for close contacts of meningococcal cases; or
  3. A maximum of two doses for bone marrow transplant patients; or
  4. A maximum of two doses for patients following immunosuppression*; or

2.      Both:

  1. Person is aged between 13 and 25 years, inclusive; and
  2. Either
    1. One dose for individuals who are entering within the next three months, or in their first year of living in boarding school hostels, tertiary education halls of residence, military barracks, or prisons; or
    2. One dose for individuals who are currently living in boarding school hostels, tertiary education halls of residence, military barracks, or prisons, from 1 December 2019 to 30 November 2020.

Notes: children under seven years of age require two doses 8 weeks apart, a booster dose three years after the primary series and then five yearly.

*Immunosuppression due to steroid or other immunosuppressive therapy must be for a period of greater than 28 days.

The Ministry of Health is responsible for supporting the implementation of changes to the National Immunisation Schedule. The Ministry of Health’s Immunisation Handbook would be updated to reflect the changes to eligibility for meningococcal ACWY vaccine(external link).


Our response to what you told us

We’re really grateful for the time people took to respond to this consultation. Responses were generally supportive of the proposal. A summary of the main themes raised in feedback, our responses to the feedback received, and changes we have made after listening to you is provided below:

Theme

PHARMAC Comment

Request to widen access further to meningococcal ACWY vaccine for a range of groups:

  • all people from 1 to 25 years of age
  • children
  • family households with more than 6 people
  • shared housing, sporting teams and all secondary or tertiary students
  • Māori living in marae situations
  • people using drug and alcohol housing services.

We are currently in a position to progress funding for individuals aged 13-25 in close-living situations. 

PTAC and the Immunisation Subcommittee have reviewed the funding of meningococcal ACWY vaccine and recommended funding with a high priority for several different patient groups. These other groups remain in active consideration by PHARMAC, in consultation with the Ministry of Health, for future funding. Information on the range of groups that have been considered and to review the clinical advice we have received is in PHARMAC’s application tracker. 

> Check the application tracker(external link)

We acknowledge that there are other types of close living situations and consider that the majority of at-risk people in these situations would be covered by the other groups currently under active consideration for future funding. 

Request to extend the funding for the whole 13 to 25 year old group to 2 years rather than 1 year before limiting it to just entrants to close living situations.

The duration of funding for the whole 13 to 25 year old group is based on clinical advice. We consider 12 months would be sufficient time to enable this population to be vaccinated, however this can be reviewed in the future if we get advice that more time is required. 

Request to also fund meningococcal B vaccine:

  • for the same close living group as this decision
  • people from 9-25 years of age in close living situations
  • all students 13-25 years of age
  • all people 13-25 years of age
  • all people 1-25 years of age with catch-up
  • for the same high-risk groups that Men ACWY vaccine is currently funded for
  • for children as part of the childhood immunisation schedule.

PTAC and the Immunisation Subcommittee have reviewed the funding of meningococcal B vaccine and recommended funding for several different patient groups. Information on the range of groups that have been considered and to review the clinical advice we have received is in PHARMAC’s application tracker.

> Check the application tracker(external link)

These other groups remain in active consideration by PHARMAC, in consultation with the Ministry of Health, for future funding of the meningococcal B vaccine. 

Request that pharmacists be able to administer the Meningococcal ACWY vaccine.

Decisions about how the national immunisation programme will be delivered are made by the Ministry of Health and DHBs. PHARMAC enables claiming and reimbursement of vaccines via the Pharmaceutical Schedule. We continue to work on changes to the Schedule that would allow pharmacists to claim reimbursement for specific funded vaccines in the event that service funders implement such an approach.

Request to amend Special Authority criteria to provide clarification that new entrants be allowed to receive vaccination prior to arrival in a close living situation.

We have amended the proposed eligibility criteria to read “entering within the next three months, or in their first year” to allow for individuals to access funded vaccine before entering close-living situations.

Requests regarding implementation and communication considerations:

  • request that changes are also updated in the electronic Immunisation Handbook, in practice management software and the National Immunisation Register
  • concern about the resource required to deliver a vaccination campaign to students at the start of the year
  • noted that resources need to be allocated for the promotion of vaccination through media and that clear communications would be required with the NZ Defence Force and Corrections.

PHARMAC has provided this feedback, regarding implementation and communication activities, to the Ministry of Health’s Immunisation Team so that this can be considered as part of its planning to support the implementation of the national immunisation programme.

PHARMAC will liaise with the Ministry regarding joint messaging to interested parties.

Who to contact

If you have any questions about this decision, you can:

Last updated: 14 November 2019

MIL OSI