Due to limited federal and state funding for vaccines, underinsured children in the United States are increasingly at risk for not getting needed immunizations, according to a study in the Aug. 8 Journal of the American Medical Association.
Led by Grace Lee, HMS assistant professor of ambulatory care and prevention at Harvard Pilgrim Health Care and of pediatrics at Children’s Hospital Boston, the study found that many underinsured children fail to receive government-purchased vaccines in either a private doctor’s office or public health clinic.
“Childhood immunization is ranked as one of the most important preventive health services we can offer,” said Lee. “Due to the increased cost of recently recommended vaccines and the lack of available funding, many states have been forced to adopt more restrictive policies for the provision of publicly purchased vaccines. Underinsured children, who used to be able to rely on public health clinics as a safety net in the past, are now at risk of not getting immunized for serious childhood illnesses.”
Childhood vaccines are funded by a patchwork of public and private sources. While some private health insurance plans cover the recommended vaccines, an increasing number require patients to pay for some of them. Due to a decline in public funding and increases in the number and cost of vaccines, many underinsured children and their families are faced with the dilemma of going without immunizations or finding a federally qualified health center or rural health center (often a great distance away) that offers government-purchased vaccines free of charge. In contrast, children who are either uninsured or publicly insured through Medicaid can receive the vaccines through the federal Vaccines for Children Program.
In one part of the two-phase study, the researchers interviewed immunization program managers from 48 states. They found that in the private sector, 30 states were unable to provide meningococcal conjugate vaccine to underinsured children, and 24 states could not provide them with pneumococcal conjugate vaccine. In the public sector, those numbers were 17 and 8, respectively. This means, for example, that approximately 2.3 million children could not receive publicly purchased meningococcal conjugate vaccine in the private sector, and 1.2 million could not receive the vaccine even if they were referred to public sector clinics.
“Studies suggest that many private clinicians refer underinsured children to public health clinics for vaccination,” said Tracy Lieu, senior author on the study and an HMS professor in the Department of Ambulatory Care and Prevention. “Unfortunately, a growing number of states no longer provide the most expensive vaccines to these children. The problem may become worse since the trend in private health insurance is to shift to higher deductible plans and, in many cases, vaccines may not be covered unless the deductible is reached. This could put children from economically vulnerable families at risk of not getting vaccinated.”
Lee warns that the situation is creating significant ethical dilemmas for public health clinicians who are being forced to turn away underinsured children or ask families to pay for needed vaccinations.