Kids’ back-to-school vaccinations will continue to be free this fall, but some people could have to pay out of pocket for their COVID-19 vaccines.
U.S. Department of Health and Human Services Secretary Robert F. Kennedy Jr., a former anti-vaccine activist, has rocked the normally staid world of vaccine policy since January, including by firing all 17 members of an advisory committee, no longer recommending COVID-19 shots for healthy children or pregnant women and declining to full-throatedly endorse the measles vaccine in the midst of the largest outbreak since the early 1990s.
The effect has been to confuse parents about whether vaccines are safe, said Northe Saunders, president of American Families for Vaccines. For now, the federal government hasn’t directly made it harder to get routine shots, though pharmacies and providers may be less likely to stock them if they think patients don’t want them, he said.
“If there’s no demand for a product because of misinformation, it’s harder to get,” he said.
Multiple medical groups, including the American Academy of Pediatrics, sued Kennedy and the Department of Health and Human Services in July over changes to COVID-19 vaccine recommendations for children and during pregnancy. They also challenged his decision to dismiss all members of the Advisory Committee on Immunization Practices and to appoint new ones who haven’t undergone the usual vetting process. Of the eight members Kennedy appointed, one has bowed out, and at least three have anti-vaccine views.
The committee’s composition matters because it has a role in determining what vaccines insurance will cover. Almost all plans legally have to cover vaccines without out-of-pocket costs if they’re recommended by the director of the Centers for Disease Control and Prevention, who usually follows the committee’s advice. If the committee and the director opted to no longer recommend a particular vaccine, insurance companies and state Medicaid programs could make their own decisions about whether to cover it.
The federally funded Vaccines for Children program also relies on the committee’s recommendations to determine which shots it will provide free to low-income and uninsured kids. If the committee decided to remove a particular shot from its list, uninsured parents would have to pay for the shots out of pocket, said Dr. Judith Shlay, associate director of the Public Health Institute at Denver Health.
In May, Kennedy announced the health department would no longer recommend COVID-19 vaccines for healthy children or during pregnancy, though it isn’t clear if that announcement frees insurers from paying because he didn’t follow the normal procedure.
For now, Vaccines for Children still covers the COVID-19 shot under the “shared decision making” paradigm, said Dana Von Schaumburg, interim clinic services director at Jefferson County Public Health.
With fully recommended shots, providers start from the presumption that getting those vaccines is a good idea, unless a child has a health condition that would make certain shots unsafe. With shared decision making, the provider and the patient, or parent, determine if a shot is right for them. For example, if someone well into adulthood wanted the human papillomavirus shot, the provider would explain that it might not benefit them if they’ve already encountered HPV, then help them decide, Von Schaumburg said.
“There’s more of a conversation about the risks versus benefits,” she said.
While healthy kids will still be able to get the COVID-19 vaccine, providers won’t be able to offer it at school vaccination events, because parents typically aren’t there to have an in-depth conversation, Shlay said. Those who want their kids to get the vaccine will need to bring them to a clinic, she said.
“Anybody who wants it, we will give it to” with the proper consent, she said.
Jefferson County Public Health is still trying to clarify if it can give COVID-19 shots to pregnant patients, Von Schaumburg said. The data shows that the virus is more dangerous during pregnancy and that vaccination also protects the baby in the months after birth, but insurers may not cover the shot now, she said. A dose costs about $200 without insurance coverage.
“Vaccinating that population is important to protect the parent and the child,” she said.
Denver Health determined that pregnant patients can still get the shot, and Shlay, a family physician, said she would recommend it.
“I look at pregnancy as being a risk” for severe COVID-19, she said.
Changes at the federal level also affect flu shots, though most people won’t notice. The new members of the Advisory Committee on Immunization Practices voted in June to require vaccine manufacturers to remove the preservative thimerosal, which is used in multi-dose vials of seasonal flu shots, even though studies have shown no link between the ingredient and autism or health problems. (Autistic people who can speak for themselves often push back on the idea that people should attempt to prevent autism, arguing that seeing the world differently can have benefits.)
Multi-dose flu shots aren’t especially important to most practices during a normal season, but they would matter if avian flu or another novel strain started spreading among humans, requiring quick efforts to vaccinate as many people as possible, Saunders said.
“While it’s a small part of the overall vaccine supply, those multi-dose vials would be crucial” in a pandemic, he said.
Saunders said he worries about the upcoming respiratory season. Flu and COVID-19 shots aren’t top of mind for most people, and the federal government has clawed back pandemic-era grants that states could use to promote immunization, he said. Last year’s flu season was relatively severe, with more pediatric deaths than is typical, according to a preliminary assessment from the CDC.
“If they continue to take away parts (of the vaccine infrastructure), it’s all going to crumble,” he said.
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