In Reply Dr Schwartz addresses cost in relation to meningococcal B vaccines and other health care expenditures. First, in terms of meningococcal B vaccines, the issues surrounding guidance for the use of these vaccines are quite complex apart from cost and are summarized in the Box. For example, both the efficacy and safety of the meningococcal B vaccines are incompletely understood.1 As noted, the risk of anaphylaxis following administration of this vaccine series may be equal to the likelihood of disease prevention.