Auckland health chiefs are questioning the Government's $200 million plan to wipe out meningococcal disease by mass vaccination.

The money will be spent over five years.

Clinical trials of a vaccine specifically targeting New Zealand's B strain of the deadly bug began in May.

If these prove the vaccine is safe and effective, the Health Ministry hopes to begin a pilot vaccination programme in South Auckland in April.

It aims to start mass vaccination of all under-20-year-olds nationwide in 2004.

The Auckland District Health Board chief executive, Graeme Edmond, raised members' concerns in a letter to the ministry.

He said the board did not understand the rationale for investing so much public money in the programme when health cash was so tight and deficits so large.

"We are not convinced that the burden of this disease in the population justifies the need to vaccinate all children and young people under the age of 20 ... "

Mr Edmond asked why the programme was not targeted at those in greatest danger - poor and Maori and Pacific Island young people.

The Director-General of Health, Karen Poutasi, replied that the money was on top of all other Government health finance, so other programmes were not financially affected.

A successful vaccination programme was likely to reduce the hospital admission rate from the disease, which would help boards' finances.

The meningococcal epidemic has caused 4506 cases and 194 deaths since it started in 1991. Up to a fifth of survivors are left with a disability or brain damage.

The vaccination strategy is expected to prevent at least 4000 cases and 200 deaths over 10 years.

"Meningococcal disease now causes more hospitalisations and more fatalities than any other notifiable infectious disease in New Zealand," Dr Poutasi said.

She cited estimates showing the epidemic had cost the country $630 million, including direct costs to the health sector of $300 million.

"Mass vaccination offers the best prospect of controlling the epidemic by raising the immunity of the most affected groups in the population."

Targeting only those ethnic and economic groups at greatest risk would not control the epidemic.

"The fewer people who are vaccinated, the lower the chance to effectively control the epidemic."

There would also be "substantial equity issues to deal with" if a more-targeted approach was used.

It would be hard to explain why people from one area should be vaccinated and not those from another with a slightly lower rate of the disease.

The Auckland board's chairman, Wayne Brown, pledged compliance with the vaccination plan yesterday.

"We will do our best," he said.

Asked if the scheme was a wise use of public money, he said: "If the Government is determined it's a good use of money, it's a good use of money."

He said that on the basis of Dr Poutasi's letter, the scheme sounded a good one, but she had failed to compare its cost-effectiveness with other programmes.