Tuesday, May 10, 2005, 12:01 p.m. ET

For more information contact:
Kari Root or Jessie Pinkrah, 301-652-1558
Jon Gardner at Health Affairs, 301-347-3930


New Health Affairs Issue Assesses Vaccine Shortages;
Calls Pediatric Vaccine Supply Precarious 

Millions of Privately Insured Children and Adults Do Not Have Coverage for Recommended Vaccines

Bethesda, MD – Despite broad public support for insurance coverage of vaccines, an estimated 15 percent of children and 30 percent of adults in the United States who have health insurance are not covered for vaccines, according to a new study published today in the May/June issue of the journal Health Affairs. In addition, the nation’s pediatric vaccine supply is considered “precarious,” given increasingly frequent shortages in several pediatric vaccines, according to another study published in the May/June issue.

The issue assesses the status of vaccines worldwide, examines implications of the 2004 flu vaccine shortage, and details vaccine coverage and supply issues. A survey, conducted by Catherine DesRoches and Bob Blendon of the Harvard School of Public Health, and John Benson of the Harvard Opinion Research Program, assesses how concerned the American public was about the 2004 flu vaccine shortage and whether they truly understood the potential flu threat.

The survey of more than 1,000 Americans found that more than half significantly underestimated the seriousness of the flu. This may have been an important factor in explaining why so many Americans did not seek flu shots. According to the survey, just 10 percent correctly estimated that the flu is responsible for 20,000 to 40,000 deaths per year.

More than half (56 percent) of Americans believe that doctors and nurses should decide which of their patients should receive influenza vaccines in times of shortage — not the federal government. Only 14 percent of those surveyed expressed high levels of confidence in the ability of government agencies, together with the vaccine industry, to ensure fair distribution of flu vaccines. At the same time, most respondents said that when vaccine supplies are scarce, they should be reserved for those at greatest risk.

“Vaccines save lives. Clearly, the nation needs to find a way to ensure the safety and supply of vaccines for Americans in need,” said John K. Iglehart, founding editor of Health Affairs. “The American public places a high value on vaccines, for children and adults alike.”

Immunization programs have been under intense scrutiny in recent months: The United States experienced a severe shortage of influenza vaccine last fall when its primary manufacturer was shut down; unsubstantiated stories about a vaccine-autism link have fueled parental anxieties; the federal stockpile of pediatric vaccines, intended to forestall shortages, has been depleted; and fears of new infectious diseases, like avian flu, have called into question the lengthy vaccine development process. The May/June issue of Health Affairs examines these and other challenges to immunization programs around the world.

Vaccine Underinsurance  

One study finds that even people with insurance may not be covered for immunizations, attributing partly to low U.S. immunization rates. As many as 5 million privately insured children and 36 million privately insured adults are not covered for immunizations — a factor that may be contributing to low U.S. immunization rates, according to study authors Matthew Davis and Kathryn Fant of the University of Michigan in Ann Arbor.

Although more than half of states require coverage of recommended vaccines for children, none requires comparable adult coverage (principally for influenza and pneumococcal vaccines), according to the study.

“Over the past few years, newly approved vaccines have been increasingly expensive, so insurance plans have been less likely to cover them,” said lead study author Davis. “This means that new vaccines of the future may be available to many people only if they can pay out of pocket.”

According to the authors, this is the first study to show broad public support for coverage of all recommended childhood and adult vaccines by employer-sponsored coverage. A majority of the 995 respondents surveyed said that they would be willing to pay higher premiums for vaccine coverage. In fact, 78 percent of people with children at home said that they would be willing to pay an additional $3 to $6 per month for vaccine coverage. By and large, they also strongly believed that vaccines are effective and generally safe.

Public Views on the Flu Vaccine Shortage

Faced with a serious shortage of influenza vaccine in fall 2004, the Centers for Disease Control and Prevention (CDC) recommended that these immunizations be provided only to specific high-risk groups. DesRoches, Blendon, and colleagues surveyed 1,277 U.S. adults late last fall to find out what they knew about the shortage and potential remedies. They found that:

Although Americans generally supported reserving influenza vaccine for people at greatest risk, the majority believed that individual doctors and nurses should decide who receives it, not the CDC (56 percent versus 16 percent).

Following the 2004 shortage, many people referred to the handling of the shortage as a successful experiment in health care rationing. But the study authors point out that many people did not seek the flu vaccine, for a variety of reasons: They felt that the threat was not serious, they perceived that they couldn’t get the vaccine, or they had safety concerns. The authors warn that if the country faced an outbreak of a lethal, highly contagious disease, it might be “much more difficult for physicians and public health officials to ration a limited [vaccine] supply based on categories of health risk.”

They also warn that the government may have a difficult time convincing the general public to get vaccinated this year because many will doubt that there is an ample supply.

Precarious Vaccine Supply

The U.S. supply of pediatric vaccine is “precarious” according to study authors Patricia Danzon, University of Pennsylvania, and Nuno Sousa Pereira, Universidade do Porto, Portugal, who cite a declining number of producers and products. “Five firms produce almost all routine childhood vaccines, and five of the eight currently recommended pediatric vaccines have a single supplier,” they write.

According to the authors, the problem isn’t likely to resolve any time soon. Vaccine manufacturing involves large research and development costs and high fixed investments in facilities and processes that must be maintained over a long period. In addition, the product is usually good for only one flu season; demand is unpredictable (less than half the people for whom the vaccine is recommended receive it); and competition keeps prices low.

Health Affairs , published by Project HOPE, is the leading journal of health policy. Copies of the May/June 2005 issue will be provided free to interested members of the press. Address inquiries to Jon Gardner at Health Affairs , 301-347-3930, or via e-mail, press@healthaffairs.org . Selected articles from the May/June 2005 issue are available free on the journal’s Web site, www.healthaffairs.org .



©2005 Project HOPE–The People-to-People Health Foundation, Inc.