‘A welcome silence’ emerges from insurance companies on COVID vaccine coverage

So far, as one pediatrician called it: “A welcome silence” from insurance companies who still appear to be paying the vaccination bills, both private and Medicaid-affiliated.

That’s just for now. Actions taken by Kennedy on Monday might change that in the coming weeks or months.

For the moment though, doctors and public health officials in Georgia say the vaccine is available and being covered as it was before.

“I haven’t heard of any changes,” said Dr. Hugo Scornik, a Conyers-based pediatrician.

All that could change as a result of an administrative shake-up that Kennedy began Monday, when he removed all 17 members of the Advisory Committee on Immunization Practices — a panel that advises officials at the CDC on vaccines.

It is unclear what impact the committee’s dissolution could ultimately have on vaccine usage and insurance coverage.

But the stakes are high for the COVID-19 vaccine in the populations targeted by Kennedy’s announcement.

There are more than 120,000 live births in Georgia each year, and about 1.7 million children, according to state data and the Kids Count Data Center.

The controversy all has to do with a key government list of recommended vaccines and timing, called the CDC immunization schedule.

Insurance companies and federal health programs often tie what they’ll cover to the schedule.

Kennedy said in a May 27 online video that “for healthy children and healthy pregnant women” the COVID-19 vaccine recommendation had been removed from the CDC’s vaccine schedule.

But the CDC didn’t remove the vaccine for those patients from the schedule after all. Instead, it tweaked the recommendation for healthy children to say it was subject to “shared clinical decision-making” by the parent and doctor.

Credit: AP

Credit: AP

As before, parents could choose. And because it was on the schedule, insurance companies would pay and public health vaccine programs for lower-income kids would supply it.

When it comes to healthy pregnant women, they had always been included without being named, because pregnancy is one of the underlying health conditions that makes the vaccine important for adults.

That didn’t change, said William Schaffner, a professor of preventive medicine at Vanderbilt University.

“Yes, providers are still carrying and offering this vaccine to their VFC-eligible patients,” said Georgia Department of Public Health spokesperson Nancy Nydam Shirek, speaking of the Vaccines for Children government vaccine supply program.

Rick Ward, a spokesperson for the Georgia Chapter of the American Academy of Pediatrics, agreed.

“It hasn’t been taken out,” he said.

The Georgia Office of the Commissioner of Insurance says they do not expect last month’s changes to affect private plans purchased on Georgia Access.

Shake-up underway

The public health landscape began shifting again Monday.

The scientists and doctors who draft the CDC immunization schedule, and who submit it to the CDC director, are called the CDC’s Advisory Committee on Immunization Practices, or ACIP.

Kennedy, a vaccine skeptic, fired the entire membership of ACIP on Monday afternoon. He said he intends to replace them with members who have a different perspective.

“A clean sweep is necessary to reestablish public confidence in vaccine science,” Kennedy said in his statement. “ACIP new members will prioritize public health and evidence-based medicine.”

ACIP members make their decisions in public meetings and debates that anyone can view. ACIP’s members have tended to be scientists with long careers in research or medical practice.

The American Medical Association, the nation’s organization of doctors, said in a statement that Kennedy’s move would have the opposite effect from building confidence.

“Today’s action to remove the 17 sitting members of ACIP undermines that trust and upends a transparent process that has saved countless lives,” the AMA statement said.

ACIP is currently scheduled to have its next meeting later this month.

How to choose a vaccine

In the mean time, parents and patients can always look at the public research and debates provided in past ACIP meetings.

Never saying a vaccine is perfect, ACIP members typically weigh whether getting a vaccine is safer than not getting the vaccine.

They have made decisions both ways. For some patients, ACIP has decided that risks of side effects tip the scale against getting the shot.

For most pregnant women and their babies, the scale is on the side of getting the COVID-19 vaccine, ACIP decided. That’s because data suggests that not getting the vaccine could be more dangerous for both the fetus and the mother.

There’s a higher rate of premature babies associated with moms who have COVID-19. In the Delta pandemic wave, there was a higher rate of stillbirths for babies of women who had COVID-19. Fetuses and newborns under 6 months cannot get the COVID-19 vaccine themselves, so they depend on getting it through their mom when she’s pregnant.

As for the mothers themselves, pregnancy puts women at risk of blood conditions like preeclampsia and blood clots. And COVID-19 is actually a vascular disease — capable of producing dangerous blood problems like microclots.

Pregnancy and COVID-19 together can be even more dangerous. Research shows pregnant women who get COVID-19 are more likely to wind up in the ICU or die than are other people who get the disease, the American College of Obstetricians and Gynecologists says.

After calculating how many people are protected from COVID-19 by getting the vaccine, the ACIP members calculated that in general it’s safer for them to get it than not.

As of Sept. 24, the CDC’s webpage for pregnant women said: “If you are pregnant or were recently pregnant, you are more likely to get very sick from COVID-19, compared to those who are not pregnant. Additionally, if you have COVID-19 during pregnancy, you are at increased risk of complications that can affect your pregnancy and your baby from serious illness from COVID-19.”

When it comes to healthy children, ACIP members have recently seemed to be easing back on their support, said Schaffner, the Vanderbilt professor, who previously served as medical director of the National Foundation for Infectious Diseases. He wouldn’t have been surprised to see the recommendation for healthy kids scaled back by ACIP members who lost their jobs Monday.