The Evolving Childhood Vaccine Schedule: Changing Recommendations Lead to Less Immunizations, Greater Health Disparities, Costs

This roundtable series discusses the ongoing recommendation changes being made to the pediatric vaccine schedule, and how this is impacting US public health.

One of the most significant consequences from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) changes in the last year has been the decision by medical societies and now some states to break with the ACIP’s recommendations on the childhood vaccine schedule. Unfortunately, this is leading to confusion about recommended vaccines, and could potentially affect vaccine costs, explains William Schaffner, MD, professor of medicine in the Division of Infectious Diseases at Vanderbilt University School of Medicine.

“You'll have to look to what's happening in each and every state. To extend this just a little bit, the insurance industry has continued to fund the vaccines, and they recognize that there is this turmoil out there, and they're still focused on the recommendations made by the previous ACIP. So, at the moment, their funding is comprehensive. We are concerned that some federal funding under the vaccines for children's program, perhaps going into the future may be in peril,” Schaffner said.

If the insurers decide not to reimburse for vaccines, this will transfer the costs of immunizations to parents, which will likely become cost-prohibitive to many families.

“The cost of these vaccines is going to be enormous. I mean, some of them are $200 to $300 a [shot]. You need a couple of vaccines each time you come in. As they age, you may have more than one kid, and that bill just goes up and up,” said Sharon Nachman, MD, chief of the Division of Pediatric Infectious Disease at Stony Brook Children's Hospital.

Nachman says another potential consequence is parents being upset about follow-up immunization studies on already approved vaccines. Federal health agencies are requesting further studies on such immunizations and want to use placebo vaccines. She uses the rotavirus vaccine as an example. This immunization was universally recommended to all children, and are now included in a new category called, vaccines offered through shared clinical decision-making. This is part of ACIP’s way of moving vaccines away from universal recommendations.

She says clinicians will need to have conversations with parents around this that will be upsetting and unnecessary. “Now that ACIP is no longer recommending the rotavirus vaccine, we're going to be giving your child placebo. Are you happy with that? ‘So you're going to give my kid a placebo when you know the vaccine works?’ Yep, that's exactly what we're going to be doing.”