Ake Ngiamsanguan
Although vaccines may have a tougher time winning the endorsement of the CDC’s Advisory Committee on Immunization Practices after HHS Secretary Robert F. Kennedy Jr. recently replaced all of its members, that should not have any implications for coverage of shots by health insurers.
Last week, RFK Jr. removed all 17 members of ACIP and replaced them with eight new ones, including several vaccine skeptics.
However, for economic reasons, health insurers are likely to still cover vaccines even if they aren’t recommended by the newly reconstructed panel, according to two health policy experts.
“The economics are there,” said Sherri Berger, the CEO of SB Strategies who spent nearly 30 years at the CDC. “It’s a lot less expensive to cover a vaccine than a hospitalization.”
“Most people are pro-vaccine,” added Luciana Borio, a venture partner at ARCH Venture Partners who has also served as a member of President Biden’s transition COVID-19 Advisory Board and Director for Medical and Biodefense Preparedness at the National Security Council. “I think insurance companies will pay for vaccines because people want vaccines.”
Berger and Borio were speaking at a panel discussion on vaccines and lawmakers at the BIO International Convention in Boston on Tuesday.
While ACIP’s recommendation of a vaccine has typically been a requirement for payor coverage, Berger said that it is likely other health organizations will need to come out with their own guidelines.
She also cited an update from the University of Minnesota Center for Infectious Disease Research and Policy’s Vaccine Integrity Project that on Tuesday came up with recommendations in an interim report. One is to work “with insurers/payers on opportunities for coverage and reimbursement under a scenario in which the ACIP is limiting or no longer recommending vaccines for use.”
Borio also called on FDA Commissioner Marty Makary to have the agency engage more with the industry given that innovation is accelerating so fast that regulations aren’t keeping up. She added that Makary needs to strengthen the vaccine review staff because of the expertise they provide and have division directors make more decisions.
A separate discussion during the BIO panel discussion centered around lessons learned from how the COVID-19 pandemic was handled by lawmakers.
Larry Bucshon, a medical doctor and former Republican congressman from Indiana who is now with Holland & Knight, commented that the debate over COVID-19 vaccines got political, and it “was a dangerous precedent to use public health as a political tool on both sides of the aisle to win elections….We can all back away from the politics of vaccines and public health in general.”
While in Congress, he said most of his colleagues were supportive of vaccines, though some of the public has questioned the role of the federal government in promoting them.
We are “wondering where we go from here on role of federal government [in vaccines] and having American public realize their benefits.”
Borio noted that much of the public didn’t realize the successes of COVID vaccination, focusing instead on failures, such as side effects. She added that people tend to focus on their individual health instead of population health, and more needs to be done to explain the benefits of vaccines on an individual level.