Access to COVID shot and 2 childhood vaccines may change this week

Americans may get some movement — but maybe not much clarity — this week on their future access to COVID vaccines and two childhood immunizations, as a federal committee convenes in Atlanta to vote on recommendations.

Public health experts are expecting mixed messages from the meeting. The committee might recommend some shots, with restrictions that could keep people confused as to who should get them.

A direct message from a nurse at Anne Goyette's primary care doctor's office at Wellstar Health System was one in a chain preventing her from getting the COVID-19 booster shot even though she is eligible and her pharmacy has it, amid confusion under HHS Secretary Robert F. Kennedy Jr.'s. Kennedy has made changes to the CDC's Advisory Committee for Immunization Practices, or ACIP. (Photo courtesy of Anne Goyette)

“For those who are opposed to vaccination, making people feel uncertain about vaccines is kind of their stock in trade,” said Brian Abramson, an attorney who has published a textbook on vaccine law.

Here’s what to know about the meeting and how it could affect access to COVID shots, as well as hepatitis B and MMRV vaccines for children.

What is ACIP? Why does it matter?

ACIP’s recommendations guide how the CDC sets child and adult immunization schedules.

The panel’s recommendations create the standards most health care providers follow and are “considered the gold standard,” said Dr. Ashley Chinchilla, a professor at the University of Georgia College of Pharmacy.

Although the Food and Drug Administration approved the vaccines for people over 65 and for adults with underlying health conditions last month, ACIP has not issued a recommendation for the updated COVID shots. That’s left patients and pharmacists in limbo, with many pharmacies requiring a prescription to get the shot, a departure from past practice.

“We’re in this holding pattern until there is an official recommendation,” Chinchilla said.

The recommendations also guide which vaccines insurers cover. Although private insurers could decide to cover vaccines even if they are not recommended by ACIP, many government programs are bound by the ACIP recommendations, said Matt Motta, a professor at the Boston University School of Public Health.

What is on the ACIP agenda?

There are three items on the ACIP agenda for this week: the MMRV, hepatitis B and COVID vaccines.

MMRV

The first item on the agenda for Thursday is the measles, mumps, rubella and varicella, or chickenpox, shot.

It combines the MMR vaccine with the varicella vaccine into one shot that was designed “to make it easier for families to give this vaccine to their children” by eliminating an extra shot, said Yvonne Maldonado, a former ACIP voting member and a professor of pediatric infectious disease at Stanford University.

There is a higher incidence of febrile seizures in young children who get the combination dose, Maldonado said, but families are advised of this risk and can decide whether to get the MMRV shot as one vaccine or separately.

“In many cases, it’s just easier to give the combination and saves the baby an extra shot,” she said.

ACIP could recommend that the MMR shot be given separately from the varicella shot, Maldonado said.

If that happens, “it’s not going to be a tremendous impact in terms of vaccination overall, as long as people continue to get MMR and V or MMRV together. But it does start to weaken the recommendations around vaccination,” Maldonado said. “It does make it harder for people to get vaccines, and it starts to make people question … what the schedule was.”

Hepatitis B

The committee is scheduled to discuss the hepatitis B vaccine on Thursday afternoon. Currently, the CDC recommends the vaccine for all infants and most adults.

Dr. Tony Fiore, a retired CDC infectious disease expert, said it’s important for the United States to continue to provide the vaccine to infants, because hepatitis B can cause serious medical conditions, like cirrhosis or liver cancer, and early death.

The blanket dose for all newborns has helped dramatically reduce cases of hepatitis B. The disease is highly contagious and can be transmitted in a variety of ways, including from mother to child.

“The vaccine is very safe,” Fiore said. He’s concerned removing the recommendation of the birth dose could lead to an increase in cases. While there are screening procedures to check pregnant women for the disease, Fiore said those are complex, and the birth dose ensures babies born to mothers with the disease do not get it.

COVID-19

The committee is slated to spend Friday discussing the COVID vaccine.

Ideally, ACIP would recommend the vaccine be recommended for everyone older than 6 months, as in past years, Fiore said.

But several public health experts said it’s more likely ACIP will follow the FDA’s decision last month to recommend the shots only for adults over 65 and adults with underlying health conditions.

That would be better than further narrowing the eligibility requirements, Motta said.

But it would mean groups outside the ACIP recommendation may have to get a prescription to receive the shots off-label, and that could jeopardize insurance coverage.

What has changed at ACIP?

Kennedy’s remaking of ACIP has drawn criticism and lawsuits from professional medical societies, including the American Academy of Pediatrics and the Infectious Diseases Society of America.