The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) will host a meeting to determine whether to lower the recommended age for the pneumococcal vaccine from 65 years of age to 50. This is an important step to improve the health of millions of Americans, and ACIP should vote to recommend. The committee will also vote to recommend one or both pneumococcal vaccines, both of which are approved by the Food and Drug Administration (FDA). Given the major deficit in trust the CDC is facing from the American public, the committee should vote to recommend both vaccines and allow patients and their doctors to choose the best option for themselves.
The logic to recommend the lower age is simple: The vast majority of doctors are going to prescribe a vaccine based on the CDC’s schedule, so lowering the CDC’s age recommendation means more doctors will be willing to prescribe the pneumococcal vaccine to their patients. From a personal perspective, my mother struggled with a bout of pneumonia that permanently damaged her lungs, resulting in a lifetime of repeated bronchitis infections. Increasing access to these valuable tools will help many Americans avoid a painful and dangerous disease.
In consideration of one vs. two pneumococcal vaccines, ACIP would be doing a great service to recommend both FDA-approved vaccines. Trust in the CDC – and public health authorities in general – has never been lower than right now, in large part because of the paternalism of the COVID-19 response. Obscure, unelected bureaucrats told Americans “we alone know the way, and even when we don’t, we alone should be trusted to decide.” As lockdowns shut people off from their communities, mental health crises spiraled, deaths from addiction shot up, and an entire generation of children experienced learning loss so severe that we will be facing the consequences for decades. The worst part: research has indicated that states with less restrictive COVID policies outperformed states with more restrictive COVID Policies.
Viewed in that light, the ensuing backlash against “experts” was predictable. Over a quarter of Americans trust the CDC “not very much” or “not at all”. The CDC is one of the few government organizations where lack of trust is a real threat to Americans’ health. When (not if) the next pandemic hits, we will need the world’s premier public health agency to have the trust of the public in order to help guide us through safely. Rebuilding that trust is going to take a long time and a lot of steps, but it must be the primary focus of the CDC for the next several years.
That rebuilding process starts with doing the basic – the fundamental – things right, especially decisions on vaccine policy. With October’s meeting, ACIP has the chance to restart the clock and begin the gradual work of restoring Americans’ faith in the CDC. We have two FDA-approved vaccines for pneumonia, there’s no good (science or health) reason to recommend one over the other. Both medicines are safe and effective. Therefore, recommending one pneumonia vaccine over the other looks like government interference – unelected bureaucrats picking winners and losers.
Patients should be able to have a conversation with their doctor about what option is best for them, not have that decided in some random office in the CDC’s headquarters in Atlanta. ACIP’s committee members are some of the brightest minds in medicine, but they can’t make decisions for every individual patient in the country – no doctor could.
There are other reasons than just restoring trust, of course. Picking one vaccine over the other will reduce competition leading to higher health care costs. It also risks supply shocks – if something goes wrong in production (or, say, a major pandemic wreaks havoc on supply chains), we’re staring yet another medicine shortage right in the face. Additionally, the lack of competition will reduce incentives to innovate in the vaccine space.
ACIP has a unique opportunity to improve public health while also increasing public trust in vaccines. Lowering the recommended age to 50 is good science and staying out of the business of picking winners and losers is good policy.
Jackson Hammond is a senior policy analyst at Paragon Health Institute
