Underinsured children receive fewer vaccines

August 07, 2007

BOSTON, Mass. (August 7, 2007)--Due to limited federal and state funding for vaccines, underinsured children in the United States are increasingly at risk for not getting needed vaccines, according to a new study published August 8 in the Journal of the American Medical Association.

The study, led by Harvard Medical School and Children's Hospital Boston Assistant Professor Grace Lee, found that many underinsured children are unable to receive publicly purchased vaccines in either the private or public sector. The authors state, "The most commonly cited barriers to implementation in underinsured children were lack of sufficient federal and state funding to purchase vaccines."

"Childhood immunization is ranked as one of the most important preventive health services we can offer," says Dr. Lee, who is a member of the Department of Ambulatory Care and Prevention at the medical school and Harvard Pilgrim Health Care. "Due to the increased cost of recently recommended vaccines and the lack of available funding, many states have been forced to adopt more restrictive policies for the provision of publicly purchased vaccines. Underinsured children, who used to be able to rely on public health clinics as a safety net in the past, are now at risk of not getting immunized for serious childhood illnesses."

Childhood vaccines are funded by a patchwork of public and private sources. While some private health insurance plans cover recommended vaccines for children, an increasing number of plans require patients to pay out of pocket for many of these vaccines. However, children who are either uninsured or publicly insured through Medicaid can receive vaccines through the federal entitlement program Vaccines for Children Program (VFC).

Declines in funding coupled with increases in the number and cost of vaccines has put underinsured children at risk for not receiving important vaccines. For example, in one part of this two-phased study, immunization program managers from 48 U.S. states were interviewed. The researchers found that in the private sector, 30 states were unable to provide meningococcal conjugate vaccine to underinsured children, and 24 states could not provide pneumococcal conjugate vaccine. In the public sector, those numbers were 17 and 8, respectively.

Put another way, roughly 2.3 million U.S. children could not receive publicly purchased meningococcal conjugate vaccine in the private sector, and 1.2 million children could not receive this vaccine even if they were referred to public sector clinics.

"Studies suggest that many private clinicians refer underinsured children to public health clinics for vaccination," says Tracy Lieu, MD, senior author on the study and also a professor at the Department of Ambulatory Care and Prevention. "Unfortunately, a growing number of states no longer provide the most expensive vaccines to these children. The problem may become worse since the trend in private health insurance is to shift to higher deductible plans and in many cases vaccines may not be covered unless the deductible is reached. This could put children from economically vulnerable families at risk of not getting vaccinated."

According to Dr. Lee, many survey participants voiced concern about their inability to provide immunizations to underinsured children. In fact, since 2004, 10 states have revised their policies in order to restrict underinsured children's access to select new vaccines.

Lee warns that the situation is creating significant ethical dilemmas for public health clinicians who are being forced to turn these children away or ask families to pay for needed vaccinations.

"Despite the ability of vaccines to prevent illness and death, our current public safety net for these services is under considerable strain," says Lee. "Strategies are needed to enhance immunization benefits for underinsured children in private health plans and to support the public sector safety net in order to ensure the protection of this vulnerable group of children."
-end-
This study was funded by the Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases.

Written by Ann Plasso

Full citation:

The Journal of the American Medical Association, Vol. 298 No. 6, August 8, 2007

"Emerging Gaps in Vaccine Financing for Underinsured Children in the U.S."

Grace M. Lee, MD MPH(1,2), Jeanne M. Santoli, MD(3), Claire Hannan, MPH(4), Mark L. Messonier, PhD(3), James E. Sabin, MD(1), Donna Rusinak(1), Charlene Gay(1), Susan M. Lett, MD MPH(5), and Tracy A. Lieu, MD MPH1,(6)

1-Department of Ambulatory Care and Prevention, Harvard Medical School & Harvard Pilgrim Health Care 2-Division of Infectious Diseases, Children's Hospital Boston 3-National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention 4-Association of Immunization Managers 5-Massachusetts Department of Public Health 6-Division of General Pediatrics, Children's Hospital Boston

Harvard Medical School has more than 7,000 full-time faculty working in eight academic departments based at the School's Boston quadrangle or in one of 47 academic departments at 18 Harvard teaching hospitals and research institutes. Those Harvard hospitals and research institutions include Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Cambridge Health Alliance, The CBR Institute for Biomedical Research, Children's Hospital Boston, Dana-Farber Cancer Institute, Forsyth Institute, Harvard Pilgrim Health Care, Joslin Diabetes Center, Judge Baker Children's Center, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Massachusetts Mental Health Center, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital, VA Boston Healthcare System. For more information visit http://hms.harvard.edu

Founded in 1869 as a 20-bed hospital for children, Children's Hospital Boston today is the nation's leading pediatric medical center, the largest provider of health care to Massachusetts children, and the primary pediatric teaching hospital of Harvard Medical School. In addition to 347 pediatric and adolescent inpatient beds and comprehensive outpatient programs, Children's houses the world's largest research enterprise based at a pediatric medical center, where its discoveries benefit both children and adults. More than 500 scientists, including eight members of the National Academy of Sciences, nine members of the Institute of Medicine and 10 members of the Howard Hughes Medical Institute comprise Children's research community. For more information about the hospital visit: www.childrenshospital.org/newsroom.

Harvard Medical School

Related Vaccines Articles from Brightsurf:

Comprehensive safety testing of COVID-19 vaccines based on experience with prior vaccines
'The urgent need for COVID-19 vaccines must be balanced with the imperative of ensuring safety and public confidence in vaccines by following the established clinical safety testing protocols throughout vaccine development, including both pre- and post-deployment,' write David M.

Safety of HPV vaccines in males
A new analysis published in the British Journal of Clinical Pharmacology shows that HPV vaccines are safe and well tolerated in the male population, and the side effects that may occur after immunization are similar in both sexes.

Model could improve design of vaccines, immunotherapies
Researchers have discovered a general property for understanding how immune cell receptors sense and respond to microbial signals, which could lead to more effective vaccines for both existing and novel viruses.

Better vaccines are in our blood
Red blood cells don't just shuttle oxygen from our lungs to our organs: they also help the body fight off infections by capturing pathogens in the blood and presenting them to immune cells in the spleen.

Challenges in evaluating SARS-CoV-2 vaccines
With more than 140 SARS-CoV-2 vaccines in development, the race is on for a successful candidate to help prevent COVID-19.

Designing vaccines from artificial proteins
EPFL scientists have developed a new computational approach to create artificial proteins, which showed promising results in vivo as functional vaccines.

Misinformation on vaccines readily available online
Parents researching childhood vaccinations online are likely to encounter significant levels of negative information, researchers at the University of Otago, Wellington, have found.

Battle with the cancer: New avenues from childhood vaccines
A new research from the University of Helsinki showed for the first time how the pre-immunization acquired through common childhood vaccines can be used to enhance therapeutic cancer treatment.

Personalized cancer vaccines
The only therapeutic cancer vaccine available on the market has so far showed very limited efficacy in clinical trials.

Doubts raised about effectiveness of HPV vaccines
A new analysis of the clinical trials of HPV vaccines to prevent cervical cancer raises doubts about the vaccines' effectiveness.

Read More: Vaccines News and Vaccines Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.