Vaccine access and uptake will be affected by the recent actions of the Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices (ACIP), but the extent remains unclear, according to experts in a press briefing sponsored by the Infectious Diseases Society of America (IDSA).
“I watched with absolute horror as the 17 members of ACIP were summarily fired and replaced with seven members who had limited expertise [in relevant areas],” Andrew T. Pavia, MD, Chief of the Division of Pediatric Infectious Diseases at University of Utah Health, Salt Lake City, Utah, said in the briefing.
Vaccines aren’t perfect, but one of the fundamental benefits of a functional ACIP is that physicians can watch the deliberations take place and look at the same data that ACIP has reviewed in making recommendations, he said. Without the careful review and debate of evidence, insurers and clinicians alike face uncertainty, he said.
Fortunately, ACIP voted to recommend a second monoclonal antibody for prevention of respiratory syncytial virus in infants and recommended that the second product would be added to the Vaccines for Children program, which provides vaccines to approximately half of all children in the United States, Pavia noted.
Lack of Vote Adds to Uncertainty
Despite much time dedicated to discussion of COVID-19, no vote occurred with recommendations for vaccination for the coming season, said Angela Branche, MD, associate professor of medicine and infectious diseases specialist and researcher at the University of Rochester, Rochester, New York, in the briefing. Despite evidence presented by CDC experts that young children and pregnant women remain at risk, the lack of a vote leaves clinicians “operating blind for the coming season as to what to do,” she said.
Although ACIP recommended universal flu vaccination, the accompanying restrictions on use of multi-dose vials for flu vaccine may pose access challenges, especially in rural and underserved communities, said Branche.
Community clinics in these areas are often pop-ups, and vaccine campaigns tend to be brief, Branche said in the press conference. The use of the now-recommended single-dose flu vaccine vials may be impractical because of the expense of storage and material needed for single-dose injections, she said. Consequently, in terms of vaccine access, communities that are already disadvantaged may be even more so, she emphasized.
More Questions as Fall Approaches
The reconstituted ACIP also stated intentions to revisit the current recommended childhood vaccine schedule, which could reduce vaccine access for children across the United States, Pavia said. Regarding the current schedule, “there is no evidence that we are giving too many vaccines to children or too many vaccines close together,” he said in the briefing.
If ACIP decided to eliminate any recommended vaccinations from the schedule, the implications are unclear, but insurers might no longer cover them and clinicians might be less inclined to promote them, Pavia said.
Currently, vaccine infrastructure of the United States includes nonpartisan, expert review of the science and the clinical recommendations for each vaccine, and many insurers look to ACIP for guidance on coverage, he added.
The presenters had no relevant financial conflicts to disclose.