Five Policy Priorities to Ensure Equitable Access to a COVID-19 Vaccine

While scientists, physicians, pharmacists and others in the public health community work around the clock to bring a safe and effective COVID-19 vaccine to the global population, much is still unknown about how, when and where the average American will receive their immunization. There are critical steps that need to be taken now in order for the country to be ready for the equitable and timely deployment of the COVID-19 vaccine. 

While the federal government is developing the initial phase of the rollout for the “at-risk” population, the patient, public health and provider communities need to work closely with state and federal policymakers to ensure the environment is ready to deploy the vaccine now and in the future. Here are five health policy issues that need to be addressed to achieve that goal.

First, states need to launch, update and enhance their immunization information systems (e.g., registries) to ensure appropriate tracking of the COVID-19 vaccine and all Food and Drug Administration-approved vaccines. Providers who administer the COVID-19 vaccine must be required to input and check the registry. Longer-term uniform policies guiding the utilization of state registries should be adopted for all FDA-approved vaccines.

Second, the federal government needs to set a flat adequate vaccine reimbursement fee for all providers to cover the cost of vaccine administration and counseling. This would incentivize all providers equally to offer and administer vaccines, such as the COVID-19 vaccine. This is especially important for providers who serve patients in low income or ethnically and racially diverse neighborhoods. 

Third, the federal government ought to collaborate with institutions such as the American College of Medical Quality, the Pharmacy Quality Alliance and the National Committee for Quality Assurance to implement existing immunization quality measures and develop new measures that are aligned with the equitable deployment of the novel COVID-19 vaccine.

Fourth, it is now clear that pharmacists will play a pivotal role in vaccine administration. The recent guidance from Health and Human Services which allows pharmacists to administer any COVID-19 vaccine that is FDA-authorized or FDA-licensed is a step in the right direction. However, the HHS direction under the Public Readiness and Emergency Preparedness Act is time-limited and mandates that it be based on a recommendation by the Advisory Committee for Immunization Practices. It is of utmost importance for states to expand and harmonize state laws governing pharmacist authority to immunize and allow pharmacists to administer all FDA-approved and authorized and ACIP-recommended adult vaccines.

Last but not least, with most therapies, an out-of-pocket cost can be a barrier to access. The federal government has stated that patients will not be burdened with an out-of-pocket cost for the COVID-19 vaccine. The administration ought to also ensure that patients are exempted from cost-sharing around vaccine administration. Further, financial barriers should be eliminated for all recommended vaccines in Medicaid and Medicare. In the near term, Congress should pass the “Protecting Seniors Through Immunization Act of 2019,” which will bring equity to the costs of vaccines in Medicare by eliminating cost-sharing for vaccines covered under Medicare Part D.

The discovery, development and manufacturing of a COVID-19 vaccine is an important achievement, but it is rendered meaningless if our health care system doesn’t support efforts to make it available to the public. Now is the time to implement policies that will ensure appropriate and equitable deployment for this and all vaccines. 

Robert Popovian is vice president of U.S. government relations at Pfizer Inc.

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