New and improved vaccines available and coming soon

November 9, 2023

The human immune system is a wonder. It can produce cells that fight a range of pathogens based on previous exposure, either through infection or inoculation. The development of safe, effective COVID-19 vaccinations in under a year helped rescue the world from the nightmare of the pandemic, and ushered in a new vaccine platform, mRNA. This mRNA platform can hasten the development of vaccines to address new mutations, and can possibly create new types of vaccines that treat many different types of illness in addition to preventing infectious disease. For instance, vaccines could help our own immune systems fight various types of cancer.

Vaccinations don’t even require an office visit for most people over the age of 3, as most are available at local pharmacies nationwide. But vaccination recommendations are getting increasingly complicated, and newer vaccines cost dramatically more per dose than traditional pediatric vaccines. Suspicion of the public health, pharmaceutical, and medical community runs deep post-pandemic.

Here’s the vaccination news that’s caught my attention recently:

Influenza:  AstraZeneca announced that the FDA is evaluating its nasal influenza vaccine Flumist for home use. The decision is expected in early 2024, so this will likely be an option for next fall. The nasal vaccine is only approved for those under 50. Both Pfizer and Moderna have announced preliminary results of a combined influenza-COVID-19 vaccine. This will mean people can be fully vaccinated with fewer shots.

MPox:  The Advisory Committee on Immunization Practices (ACIP) has recommended routine MPox vaccination for those at risk (men who have sex with men and transgender people- see the full list here). Currently, about 39% of those at risk are estimated to have received one dose, and 24% of those at risk are estimated to have received two doses of this vaccine. Assuming this recommendation is approved by the CDC director, employer-sponsored health plans will be required to cover this vaccine without cost sharing starting in 2025. Employers will be able to choose to cover without cost-sharing earlier. The federal government has been providing MPox vaccinations without charge, but the vaccine costs will become the responsibility of health insurance plans later this year. The vaccine is expected to cost $150-200 per dose.

Meningococcus:  ACIP also recommended coverage of a new meningococcal vaccination which covers five different subtypes. This vaccine could replace two different vaccinations (one of which covers Meningococcal subtype A viruses; the other covers Meningococcal subtype B viruses. The two earlier vaccines will remain on the market, so this will increase complexity for pediatricians and family physicians. Assuming this recommendation is approved by the CDC director, employer-sponsored health plans will be required to cover this vaccination with no cost sharing as of the next plan year (2025 for most employers), although employers can choose to cover without cost-sharing as soon as the vaccination becomes available. The advantage of covering with no cost-sharing earlier is that this is far easier to explain to parents!

RSV:  We had high hopes that the monoclonal antibody Beyfortus would substantially decrease pediatric hospitalizations this fall. This drug is being treated as if it’s a vaccine by the CDC. However, supplies to treat newborns during RSV season are very low, and many hospitals and doctors are limiting treatment to premature babies or those with lung disease at highest risk. This is terrible news, as RSV is a leading cause of hospitalizations of infants- including those not at high risk. Women in their last trimester can protect their newborns by being vaccinated with the adult RSV vaccine, which is much more readily available (and costs only half as much).
 

COVID-19:  Only about 7% of Americans report they have already gotten the new fall COVID-19  vaccination, although another 25% say they intend to get it, and 31% say they will probably get it or are unsure. This means that many could face the fall without substantial immunity. COVID-19 infection rates have plateaued in most of the country, although we still could see a substantial surge in December based on a newer variant. A study out this week found that the COVID-19 vaccinations prevented 2.4 million deaths globally, creating economic value of $6.5 trillion.

Implications for employers:

-        Expect the cost of vaccinations to increase substantially in the next year, which is a combination of valuable new vaccines becoming available and the government no longer paying for vaccines for COVID-19 and Mpox as these public health emergencies end.

-        Shortage of the RSV monoclonal antibody means we will miss the chance to prevent many hospitalizations of infants this fall.

-        Vaccination to protect against fall respiratory viruses will likely be easier next year, with availability of home nasal vaccines and flu-COVID-19 vaccines.

-        It’s not too late to encourage employees to get flu and COVID-19 vaccines this fall! Flu season peaks in January-February, so now is the best time to get a flu vaccine.

Thanks for reading.  You can find previous posts in the Employer Coverage archive

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