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The Hidden Reason Behind Low Vaccination Rates In The U.S.

It is widely agreed upon by health professionals that immunizations are one of the top few greatest advancement in public health – on par with clean drinking water. However, despite the known success of vaccines in reducing morbidity and mortality, immunization rates remain relatively low across the U.S. in 2019, especially in the 19-35 month age range. But Americans who blame anti-vaccination parents aren’t considering the full immunization story in the United States.

Yes, those who do not vaccinate their children do play a role in our failing rates (and recent lies about vaccinations causing Autism make matters worse), but there are less known, more significant causes to poor immunization completion rates for children. Primarily, money and time.

Low immunization rates are the result of a misaligned financial incentive structure for vaccination providers, and thus, transferred to parents.

Parents have a lot of difficult choices to make. And there are legitimate cost-benefit analyses to be done that include weighing vaccination risks such as allergies, as well as an intensifying mistrust in the traditional institutions in the U.S. But there is also a growing need to recognize that as the world globalizes, travel increases, and bacteria evolve, individual vaccinations and herd immunity are vital for community safety.

Sadly, this has become more difficult as the number of recommended vaccines has nearly tripled–increasing from 10 doses in 1983 to almost 30 doses in 2015 – many with an individual monetary and time cost for parents.

For example, the conventional model for dispensing vaccines includes: four DTap, three polio, one MMR, three Hib, three Hep B, one varicella, and four PCV (4:3:1:3:3:1:4), for a total of 19 antigens being administered. Using traditional, monovalent vaccines, these 19 antigens are administered via many separate injections with separate fees.

Unfortunately, as the number of recommended childhood vaccines has nearly tripled, the likelihood of on-time and successful completion of vaccination series is reduced. Further, families living below the poverty line are less likely to complete their vaccination series due to the added financial and time constraints. For example, a 2016 study found that 40% of children living below the poverty line had not received even a single dose of Rotavirus.

Follow The Money

This begs the question, why don’t doctors use more combination vaccines? Combination vaccines take two or more vaccines that could be given individually and merges them into one shot. One sad answer is that no one is financially incentivized to. Vaccinations make doctors almost no money, and therefore the more shots they give, the more money they make. Which is the exact problem health care faces in so many areas that reimburse using a fee-for-service model – and thus, a barrier to achieving higher vaccination rates.

Although the ACA attempted to address the issue of misaligned payments by increasing primary care Medicaid vaccine reimbursements, both Medicaid and private insurance still make earnings for doctors who administer vaccinations almost impossible. For example, reimbursement for Medicaid vaccine administration varies by state, but it’s as low as $2 in some states, often leaving providers with a net loss for administering a shot. Further, study findings note that 10% of family physicians already do not give vaccines to children, and there is serious consideration by another 10% to discontinue childhood vaccination practices because of costs.

At present, using combination vaccines, the recommended antigens for children could be administered in as few as 13 shots, saving parents time and money. And combination vaccines have proven to enhance immunization rates and timeliness of vaccine delivery. With greater focus on this area by the medical community, there are also further combinations that could be created.

But the saddest part of the ongoing misalignment of incentives for vaccination, is that children are the ones who suffer. Low reimbursements mean doctors lives are made harder by trying to make ends meet while doing their jobs, and parent’s lives are made harder by trying to stick to the government proposed (and sometimes mandated) schedule at higher costs.

Utilization of combination vaccines has been endorsed by the Advisory Committee on Immunization Practices (ACIP) at the Centers for Disease Control (CDC) as a safe and efficacious way to decrease the number of injections needed to complete the childhood immunization schedule. As such, the CDC, the American Academy of Family Physicians, and the American Academy of Paediatrics strongly recommend children receive combination vaccines whenever possible as a means of improving completed vaccination series rates for children. It’s time to recognize the significant and detrimental role monovalent shots are having on America’s youth, and properly incentivize doctors – and parents – to vaccinate children to the best of their ability.

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