Roughly four years ago, influenced by the recommendations of an advisory board of the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services approved Medicare coverage of an improved pneumococcal vaccine for millions of Americans age 65 and older.
This decision was widely applauded by advocates because it would result in more older adults getting vaccinated against pneumonia.
Yet, it is entirely possible that even before the current flu and pneumonia season is over, this same CDC advisory board, the Advisory Committee on Immunization Practices, may totally reverse itself and drop its recommendation for coverage, meaning that Medicare may end its coverage of this vaccine.
Why? At the ACIP October meeting, some ACIP members said they feel there may not be adequate data to support continued coverage. They also said that we don’t know the full picture of pneumonia, especially the direct and indirect benefits of pneumococcal vaccination among the older adult population versus that of vaccinations for children that help with overall lessening of disease burden. However, what does remain clear among the entire ACIP membership is that pneumococcal vaccination is safe and has been effective.
In my judgment, the risks of reversing Medicare coverage for the pneumococcal vaccine far outweigh any benefit. And ironically, this debate is happening just after the CDC released a report showing that mortality due to influenza and pneumonia increased the most in 2017 in the wake of a deadly flu season.
Every year in the United States, nearly 1 million people get pneumonia, and many times, pneumonia is a complication of influenza. About 18,000 older adults die from pneumonia annually, and in fact, flu and pneumonia were the eighth-leading cause of death in the United States in recent years.
The 2014 approval of coverage has allowed for improvements in pneumococcal vaccination coverage among those 65 and over, and now 60 percent of the overall population has been vaccinated. However, for the trend to continue and reach the U.S. public health goal of 90 percent of older adults being vaccinated, Medicare coverage must be maintained.
Ending Medicare coverage would also disproportionately impact minority older adults; among these populations, rates of vaccination are well below the average of 60 percent but have risen since Medicare coverage has been in effect.
Further, there has not been a long-enough period of coverage to collect and review meaningful data, and therefore a ruling to remove this vaccination from the existing list of recommended vaccinations for adults is premature and would be an unprecedented move by this committee. Any decisions around current pneumococcal vaccinations should not be made until enough data is available.
Many older Americans continue to live vibrant, active lives specifically because they are healthy. We need to continue to promote and protect proactive health measures such as vaccination to keep our aging population healthy. The nation’s health experts should be directing more older adults to get this pneumococcal vaccine, not to end coverage.
Bob Blancato is the executive director of the National Association of Nutrition and Aging Services Programs.
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