In the wake of the COVID-19 pandemic, the CDC's role in public health crises remains under enormous scrutiny, especially the agency’s highly influential Advisory Committee on Immunization Practices (ACIP). ACIP meets thrice yearly, including an upcoming meeting at the end of October. One of its primary responsibilities is to set recommended vaccine schedules and determine which vaccines to recommend for specific, defined groups among the population.
Among the topics up for a vote in October is lowering the recommended age for the pneumococcal vaccine to those 50 and older. The pneumococcal vaccine protects against bacterial pneumonia, a common and dangerous disease. Currently, there are two approved pneumococcal vaccines, both recommended for those 64 and older, and young children.
This should not be a difficult decision. As Dr. Robert Goldberg from the Center for Medicine in the Public Interest points out, lowering the age of eligibility for these vaccines will “significantly reduce health expenditures, avoid preventable illnesses, and increase overall life expectancy in this population.”
A concerning issue, however, is ACIP has not made clear whether one or both vaccines are under consideration for the broader age range recommendation. The header on their website reads “Pneumococcal vaccines,” but the information below uses “vaccine” in the singular instead of the plural. This lack of clarity is unfortunate, given the loss of public trust the CDC and other public health agencies have endured since the COVID-19 outbreak, specifically due to a lack of clarity in health instructions.
Still, lowering the recommended age for the pneumococcal vaccines is a welcome development. The two approved vaccines protect against different strains of pneumonia, a disease that is commonly fatal in older adults. More than 1 million people are hospitalized with pneumonia yearly, and roughly 41,000 die, with the majority of those being over 50. Only 23% of adults have ever been vaccinated against pneumonia, and the majority of them are older. While the United States rate of death per 100,000 is low, providing protection at a younger age will reduce stress on the healthcare system and lower the number of deaths. A focus group of healthcare providers, when asked by ACIP whether the age recommendation for pneumococcal vaccines should be lowered, were 90% in favor.
However, ACIP must be clear to lower the age recommendation on both forms of the pneumococcal vaccine, not just one. Both forms are FDA-approved, so there is no reason to favor one over the other. If ACIP were to select one at the expense of the other, certain pneumonia variants would not be covered, leaving millions of Americans at risk against certain pneumonia strains.
Further, many older Americans rely on Medicare and Social Security, and picking one over the other would create coverage issues where a needed preventative is too costly for those living on fixed incomes. In the immediate term, this would likely create significant supply issues with the chosen vaccine, as a larger age group seeks access to the shot with no expanded supply. This effect would be compounded as we head into colder weather when pneumonia becomes more prevalent. Picking a preferred shot would also further complicate an already complex pneumococcal vaccine schedule, making it harder for older adults, who often struggle with technology, to keep on top of their health care.
ACIP needs to make the right choice here and approve both vaccines for wider access. In the wake of the pandemic, a polarized public will continue to question whether public health agencies have their best interests at heart. The CDC shouldn’t be playing doctor but letting consumers’ actual physicians and providers make these important decisions, with all viable options available to them.
Medicine is absolutely the worst place to instigate a policy of one-size-fits-all, precisely because it never does. Patients and their providers should always have options, and the ability to make informed decisions. ACIP has the easy decision this month to save lives and save healthcare costs by expanding access to critical pneumococcal vaccines. We urge them to do so.
Gerard Scimeca is an attorney and serves as chairman and co-founder of CASE, Consumer Action for a Strong Economy, a free-market oriented consumer advocacy organization.
