As far as sticker prices go, the vaccine recommended for children in the US is not cheap. A shot of hepatitis given within the first few hours of birth can be purchased for around $30. Rotavirus vaccines cost between $102 and $147. The full course of vaccines protecting against pneumonia and meningitis is around $1,000.
Virtually every child receives these shots for free. Legally, the federal government requires that most insurance cover around 30 different shots for children, without co-payments. Children who use Medicaid or uninsured children can also get free shots thanks to the CDC program, known as a vaccine for children. VFC is widely seen among public health experts as a commonly known unmitigated success. After the program was created in 1994, "The illness was declining and life was much easier for the family," former CDC employee Anne Schuchat told me. About half of American children are eligible to receive the vaccine via VFC.
Its ease and simplicity may be changing. This week, the CDC's Advisory Committee on Vaccination Practices that Lead to U.S. Vaccine Policy (ACIP) has been here for the second time since Robert F. Kennedy Jr. fired the entire panel. New members appointed, Some people lack vaccine expertise, and others express anti-vaccine views (or both). That was the case at the meeting Confusing, controversial, and indecisive. But the votes it experienced are beginning to point towards a changing, more destructive landscape for children to access the vaccine.
Yesterday, ACIP voted to remove the co-measles-Munz-Rubella-Baricera (MMRV) vaccine from the childhood immunity schedule of children under the age of 4, and instead recommended that they get two separate shots for one for measles, mumps, and Valisera. This morning, the panel also voted to remove the shooting combination from the VFC program. Both votes were motivated by concerns about vaccine safety, including an increased risk of febrile attacks. (As the CDC website I'll point it outthese attacks can be stressful for families, but most children will recover completely. )
Most children in America already receive separate shots, so the impact of travel from a combined vaccine is limited. However, one group will bear the brunt of change over others: children in the VFC. Some parents may choose the convenience of single shots, and those covered by private insurance may still be able to get it. Private insurance companies no longer need to cover joint MMRV vaccines for free, but they have already pledged to continue their business as normal. These vaccines pay from your pocket. Disproportionately poor children subject to VFC do not have the same kind of wiggle room. Free shots and when you can get from the program Direct It is related to ACIP recommendations. (A spokesman for the Department of Health and Human Services told me that the move would not increase vaccine inequality, but did not explain it further.)
Mainly, the changes that ACIP is currently considering will create inconvenience for poor families. But as my colleagues, Tom Bartlett and Katherine J. Wu. I wrote it yesterdayMMRV policy changes can send a message that although minor, vaccines are essential. The committee also discussed delaying when children should shoot hepatitis, but ultimately decided to make an expected vote on whether to recommend delays. (Kennedy speculates that hepatitis vaccines can cause autism despite the lack of data indicating a link between the two.) If the hepatitis vaccine or another shot is removed entirely from the schedule, you will be attacked by a child provided by the VFC.
Beyond potentially serious disparities, more changes in pediatric vaccines can cause more confusion. Kennedy's recent change to Covid-Vaccine policy narrowed down approvals for Covid shots to be recommended only for people over the age of 65, or those with certain underlying conditions, so many Americans weren't sure if and how they could get it. (Today, ACIP also voted that everyone should consult with a clinician before consulting with a clinician.) Americans who rely on VFC may need to know where to find out what shots they can get right away. The confusion surrounding the Covid shots "will give you a little glimpse into what will happen," Schuchat told me, if ACIP moves forward with changing its childhood and vaccine schedule.
If the vaccine is removed from the schedule, the experts I spoke to expect that some entities, such as the state health department, community health centers, and philanthropy, will step in to provide free shots to uninsured children. But who or what can be provided on the scale that is needed is an open question. "It's going to take some kind of extraordinary effort to provide that access," said Richard Hughes IV, a lecturer in law at George Washington University Law School. VFC works very well because it not only provides vaccines for free, but is also designed to ensure that doctors can always bring the vaccines to their hands. CDC purchases the vaccine and provides it to doctors for free.
Experts have told me that Medicaid can still provide some backstop to the poorest children, but perhaps the scenario appears to be a system in which private insurance companies continue to cover the vaccine. Such a scenario is "the definition of healthcare disparity," told me Christophe Diacio, a pediatrician in North Carolina.
The United States has previously seen inequality in this type of vaccine. From 1989, measles tore apart several cities, including Los Angeles, Houston and Chicago. "The majority of the problem was that the kids were in the doctor's office, but because they didn't have insurance, the doctors were referring their families to the health department," Schuchat told me. "That extra visit was something parents didn't find time to reach," the researchers estimated that non-white preschoolers were 7-10 times more likely to contract the virus than white children. It was this occurrence that led to the formation of the VFC program in the first place.
In his time as Secretary of Health and Human Services, Kennedy argues that Medicaid reforms will improve the program despite predictions from the Congressional Budget Office. He destroyed minority health offices in his department in the name of government efficiency. And he said that despite overwhelming evidence to the contrary, the vaccine changes will be in line with the latest science. Now, in the name of following science, Kennedy is at the forefront of creating a two-layer vaccine system.