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That virus is near 100% deadly and there's a vaccine. How comes that not everyone is vaccinated?
by choeger 5y ago
That virus is near 100% deadly and there's a vaccine. How comes that not everyone is vaccinated?
- Kuinox 5y ago" In 2015 in the United States, a course of three doses could cost over $1,000, while in Europe a course costs around €100." Wikipedia (https://en.wikipedia.org/wiki/Rabies_vaccine#Cost https://en.wikipedia.org/wiki/Rabies_vaccine#Cost)
- fmakunbound 5y agoI had the post exposure protocol (3 vaccine and immune globulin shots) and in 2018 in the US it was about $5000. Also, you should not wait for the test results to come back after being exposed. By then it’s too late if you’re positive for it, so you kind of have to suck it up given that it’s near 100% fatal. I got a lab report back about a week later. I was not exposed to a bat, but interestingly it is estimated 1 in 10 bats under the famous Congress Avenue bridge in Austin, Texas have rabies. Not sure what the spectator draw https://www.austinbats.org/ https://www.austinbats.org/ is, given that.
- pessimizer 5y agohttps://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/article_thumbnails/infographics_social/January_2018/Rabies.png https://img.webmd.com/dtmcms/live/webmd/consumer_assets/site... "The treatment regimen for rabies was first developed in the late 1800s, and it hasn’t changed much over the last 100 years. "But the price of survival has gone up rather dramatically -- nearly 400% over the last decade for those shots. "That rise is part of the reason why people who have insurance coverage may be stuck with hundreds of dollars in out-of-pocket costs, while the uninsured and underinsured often face thousands of dollars in medical bills. "In 2007, for example, vaccine maker Sanofi Pasteur charged an average wholesale cost of $740 per 10 milliliters for its Imogam immunoglobulin, a purified blood product that is the most expensive part of the rabies treatment. Ten milliliters is the standard dose for an adult who weighs between 134 and 166 pounds. "By 2017, the company charged $3,612 for the same dose, an increase of 388% over the last decade, according to First Databank, a company that tracks pharmaceutical costs. "HyperRAB, the other brand of immunoglobulin on the market, has seen price increases of 370% over the last decade." https://www.webmd.com/a-to-z-guides/news/20180220/the-high-cost-of-surviving-rabies https://www.webmd.com/a-to-z-guides/news/20180220/the-high-c...
- pupppet 5y agoBecause hospitals aren’t full of people with rabies.
- wyldfire 5y agoBut...neither are they full of people with varicella (nor were they ever). So that's clearly not the only reason to vaccinate people. I suppose rabies doesn't spread as easily between people, that might be a likely reason we don't vaccinate for it.
- throwaway0a5e 5y agoThe rabies vaccine is expensive, unpleasant, only confers protection for a limited time and is still effective after exposure but before the disease develops. There's no point in wasting the money to subjugate everyone to that when you can just vaccinate the people who have come in contact with rabies or are at risk of having done so.
- t-writescode 5y agoIt’s expensive because America wants it expensive. It’s not expensive in other countries (PReP isn’t. PEP is). It’s also not unpleasant. PEP is because it’s a lot of shots, but PReP is just, like, 3.
- refurb 5y agoNo it’s expensive because vaccinating 360M people when 1-2 died each year now isn’t cheap even when a PreP dose is cheap.
- t-writescode 5y agoPReP would be cheaper, actually. And, most people pay for their vaccines via insurance. The flu shot isn’t free.
- cottager2 5y agoBecause almost no one gets rabies and the vaccine is effective if it’s administered after exposure.
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- LurkingPenguin 5y agoI suspect you're being facetious, but I'll bite (ha): rabies pre-exposure vaccination requires (usually) 3 doses and is quite expensive (you could expect to pay over $1,000 for the series). Pre-exposure vaccination does not eliminate the need for post-exposure prophylaxis. If you have pre-exposure vaccination, you won't need human rabies immune globulin (HRIG) post-exposure, but that's a bigger benefit in isolated regions and the third world, where HRIG might not be easily accessed, than it is in the developed world. Since most people in the developed world do not live in areas where rabies is endemic and/or where they are frequently in high-risk environments, and they can access the necessary prophylaxis in an emergency, the cost-benefit does not favor pre-exposure vaccination for most people. Also note that rabies pre-exposure vaccination doesn't last for life. You usually need a booster every year that you remain at high risk.
- oasisbob 5y agoSounds like you know this, but Rabies PrEP can be had overseas far cheaper. IIRC, the WHO protocol is down to two doses from three. Did my last round of travel jabs in India. Ended up being less than $200 for everything, including rabies prep, for two people.
- whyenot 5y agoIt's a three shot vaccine that only gives protection for two years. Considering how rare rabies infections are in humans, it seems like it makes more sense to treat people after they are bitten and only vaccinate those who may come in contact with infected animals.
- hammock 5y agoCouldn't we all take the three shots every two years on a schedule?
- atrus 5y agoI mean, we can't get people to take two shots for something that's killing thousands, and you think you'd be able to get people to get three shots every two years for something that kills...basically no one?
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- mynegation 5y agoThat would be a massive healthcare spending and logistical challenge with negligible reward. The system works pretty well given that state of Illinois had its first case in 67 years and even that was only because individual refused treatment.
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- kybernetyk 5y agoWe’re about to. Just not for rabies.
- Cerium 5y agoBesides, what's the point? If after a year you are exposed would you trust a year old vaccine or get a fresh round anyway? Universal rabies vaccination might not even change best practices.
- elliekelly 5y agoI think “high risk” people like veterinarians are. I used to do a lot of traveling (in the before times) so I’m vaccinated and it’s definitely the toughest vaccine I’ve had. I felt genuinely ill after the first dose. Fortunately the second dose was much easier.
- dangerbird2 5y agoHumans don't spread rabies. Because the main aim of vaccination programs is to prevent spread in a population, not necessarily prevent disease in individuals, it's much more effective to vaccinate pets and other animals that can spread the disease through bites. In some places, they've even been able to vaccinate wild animals with vaccine-laced bait[1]. [1]https://thefactsource.com/switzerland-rabies-epidemic-air-dropping-chicken-heads/ https://thefactsource.com/switzerland-rabies-epidemic-air-dr...
- teeray 5y agoIt basically buys you more time to do the PEP protocol. It’s not completely protective. I had it done at a travel clinic when I was planning to go to Madagascar. That would buy me time to get to South Africa or Europe for the PEP. Even then, it was a three shot course over multiple weeks, and each one made my arm very, very sore—tetanus shot times 10, at least on the pain scale.
- pvaldes 5y agoThe history of rabies in Europe is particularly interesting. Rabies has been eradicated between 80's and 90's from France, Finland, Belgium, Switzerland, etc when the countries started to develop programs to vaccinate the main wild reservoir (and is not a bat, it was the red fox). The problem was reduced by an 80% or eradicated in many countries. Currently things are starting to became more complex because we have a new actor coming from the east that is basically an European coyote, the golden jackal and because the 2008 crisis hit hard reintroducing the problem in Greece. Poland had problems with rabies also but vaccination of wild carnivores worked really well when culling failed loudly. Is the way to do it.
- s1artibartfast 5y agoBecause only 2-3 people die from the virus a year so the medical benefit does not outweigh the risks. Neither does the financial cost benefit. Even at $10/per shot, it would cost >$1 billion per life saved.
- pvaldes 5y agoSome vaccines can be used once. The risk increases in the next shoots, so you need to choose the time and do a risk vs benefit calculus.