Last October the Institute for Policy Innovation (IPI) hosted a Capitol Hill briefing on the issue of vaccines. One of the panel members, Dr. Richard Judelsohn, a long-time pediatrician and the medical director for the Erie County Department of Health (and, sadly, recently deceased), discussed his concerns about the changing environment at the Centers for Disease Control (CDC). Click here for the video link.
Dr. Judelsohn, who worked at the CDC for a few years after med school, explained why he believed that costs were playing a growing role in the CDC’s decisions. And he cited the CDC’s reluctance to provide a “routine” recommendation for a new FDA-approved meningococcal vaccine for infants as just the latest in a string of warning signs.
Well, we may be seeing another.
In December the FDA approved Prevnar 13, a pneumococcal 13-valent conjugate vaccine, for people age 50 and older. When the FDA approves a vaccine, the CDC’s Advisory Committee on Immunization Practices (ACIP) then reviews it and nearly always recommends it. A “recommendation” opens the door for Medicare and Medicaid, and usually private health insurance, to cover the vaccine.
Given the strong FDA approval, an ACIP recommendation should be pretty much a given. Except that it hasn’t happened yet. And while the issue is on the agenda for ACIP’s February meeting, it isn’t even scheduled for a vote.
Ironically, Secretary of Health and Human Services Secretary Kathleen Sebelius was recently quoted in several news stories about lower premiums in the Medicare Advantage program boasting how much the Obama administration has done to improve access to health care for seniors. Well, ensuring seniors have access to Prevnar 13 should be one of the items on her list, but it isn’t—at least not yet.
Since President Obama made cutting health care costs one of the key goals of his administration, and of his health care law, there have been concerns that one way he would achieve that goal would be by denying patients access to the newest technology. ACIP and the CDC are supposed to make their decisions independently of political pressure; but we all know how that works.
We don’t know if political—or cost—pressures are what’s behind the delay in an ACIP recommendation, but vaccines are one of the most cost-effective preventive measures in medicine. If Prevnar 13 isn’t recommended, and soon, it will begin to look like a trend, and another of those warning signs that so concerned Dr. Judelsohn.