The Other Vaccine Denial
There’s another insidious kind of vaccine denial – denial of coverage. The good news is there’s a piece of pending bipartisan legislation to address it. HR 1978, The Protecting Seniors Through Immunization Act, would eliminate out-of-pocket costs for vaccines covered under Medicare Part D and improves vaccine awareness and education for beneficiaries.
Some background: In the US we spend about $26.5 billion annually treating four major vaccine-preventable diseases among US adults (flu, pneumococcal, shingles, pertussis). Vaccines covered under Medicare Part D—such as Tetanus, diphtheria, and pertussis (Tdap) and shingles—require varying levels of out-of-pocket costs for patients that can reduce acceptance of vaccines and therefore affect vaccine rates. By contrast, vaccines covered under Medicare Part B—such as flu and pneumococcal— require NO out-of-pocket costs from patients, leading to higher vaccination rates.
Beyond these four major vaccines, there are additional important public health imperatives addressed by HR 1978:
COVID-19: A component of combatting COVID-19 is a wider adoption of preventive health strategies to reduce the burden of co-morbid conditions that put people at higher risk of worse outcomes of COVID-19. Immunizing indicated populations against non-COVID-19 vaccine-preventable diseases (VPD) will both contribute to better health outcomes overall and preserve vital capacity at hospitals by reducing preventable admissions.
Pandemic Preparedness: The COVID-19 pandemic demonstrated all too clearly how important vaccines are to both the physical and economic health and well-being of Americans. And our seniors suffered greatly from this disease. We need to ensure that Medicare beneficiaries never face financial barriers to getting vaccinated, whether it’s for an infectious disease that caused a global pandemic or any other debilitating or life-threatening condition. Congress should permanently eliminate all cost sharing for vaccines in Medicare D to ensure seniors don’t face financial barriers to getting life-saving preventive services.
Highlighting Appropriate Utilization and Building Confidence: The stated goal of cost sharing is to reduce inappropriate healthcare utilization. Immunization has health benefits for both the individual and for society and should be incented, not discouraged. By waiving the cost share, Congress recognizes and signal that vaccines are a safe and effective tool in public health. As more people become immunized, the practice becomes more ensconced in the community as part of preventive health.
Reducing Hospital Burden: Reducing unnecessary hospitalizations by increasing access to Part D vaccines will reduce hospitalizations. Vaccines in development can reduce hospital burden even further. For example, in the future, immunizing Medicare Part D beneficiaries against Clostridioides difficile (C. diff) and Respiratory syncytial virus (RSV) would reduce the diversion of hospital resources dedicated to responding to these infections and in the case of C. diff, eliminate a hospital-acquired condition to which Medicare assigns financial penalties and C. diff and RSV vaccines also represent immunizations against conditions which would otherwise be treated with antibiotics. Preventing infection through immunization contributes to the national effort to combat antimicrobial resistance.
Beyond COVID-19, fully vaccinated public is an investment in the health, well-being, and economic success of our nation.
Peter J. Pitts, a former FDA Associate Commissioner, is President of the Center for Medicine in the Public Interest and a Visiting Professor at the University of Paris Medical School.
