Vaccinations have been increasingly in the news, and last month the newly constituted Advisory Committee for Immunization Practices (ACIP) met for the first time, and the U.S. Supreme Court upheld the constitutionality of Affordable Care Act cost waivers for recommended vaccines.
Vaccinations prevent illness in those who receive them, and high community vaccination rates reduce the chance of epidemics of many infectious diseases. Vaccinations that are recommended by the ACIP broadly or those administered after shared decision-making with the provider are required to be covered without cost sharing in employer-sponsored health insurance plans.
Fall respiratory illnesses like influenza, COVID-19 and respiratory syncytial virus (RSV) cause millions of illnesses each year. They are especially dangerous to the elderly, to very young children and to those who are immunocompromised, either through illness or through treatment that impairs immunity. Almost 7% of adults in the U.S. are currently immunocompromised. Decreased respiratory illnesses among employees and their families means less time away from work.
Influenza vaccines are currently recommended beginning at six months of age. Children need two shots the first year they are vaccinated for the flu. The ACIP meeting voted to recommend against using multi-dose flu vaccines that contained thimerosal, a preservative used in only 4% of flu vaccines. Influenza vaccines are required to be covered by employer-sponsored health plans without cost sharing.
This spring, the Secretary of Health and Human Services (HHS) said that COVID-19 vaccines would no longer be recommended for healthy children and healthy pregnant women. They would only be recommended for people age 65 and older and those with serious illnesses. The Centers for Disease Control and Prevention’s new guidance says that COVID vaccines should be given to healthy children and pregnant women based on joint decisions between parents/patient and clinicians. The ACIP didn't say anything about COVID vaccines at its June meeting. The HHS determination is the subject of a lawsuit from multiple medical professional societies. Guidance could change further in the coming months. Here’s a list of underlying illnesses, which include common conditions such as obesity, inactivity and pregnancy. The Food and Drug Administration estimated that 100 to 200 million will be eligible for the COVID-19 vaccination under these new guidelines. Most employers are likely to continue to waive cost sharing for COVID-19 vaccines for all members at this point.
The RSV vaccine is recommended for pregnant women in the last trimester during the fall, and for those over 75. The ACIP meeting expanded indications to those between 50 and 74 at higher risk. The ACIP meeting also voted to recommend the newer RSV vaccine for infants eight months and younger who aren't protected by maternal vaccine. The combination of the RSV vaccine in pregnancy and RSV monoclonal antibodies was credited with a 43% decline in infants under seven months hospitalized with RSV this fall and winter compared to before the COVID-19 pandemic. The vaccine in pregnancy is less expensive than the monoclonal antibody given to newborns and provides protection for both mother and newborn. Employer-sponsored health plans are required to offer RSV vaccines without cost sharing for pregnant women, those over 50 with risk factors and all those over age 75.
Since there are fewer recommendations for COVID-19 vaccinations, some members might have difficulty locating providers who stock these, especially in pediatric doses. Some local health departments have cut back on vaccine clinics due to federal cuts. You can continue to offer coverage through your medical or pharmacy benefit so that your members can receive vaccinations either at their provider’s office or at a local pharmacy. You may also consider offering flu-shot clinics to increase use of the influenza vaccine among your workers.
There will likely be respiratory virus outbreaks during next fall and winter, even with robust vaccination efforts. You can protect those in your workplace by improving indoor air quality through increased filtration and air exchanges. You can also allow remote work for those who are immunocompromised and can be “mask friendly” for employees who perceive themselves to be at higher risk.
Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.
