The racial and ethnic gaps are wider in doctors’ offices than pharmacies, which are more likely to stock both high-dose and standard vaccines, said Dr. Salaheddin Mahmud, director of the Vaccine and Drug Evaluation Centre at the University of Manitoba and first author in the report, which was funded by Sanofi.
In a more recent, as-yet-unpublished study that included data through 2018, Mahmud found that Southerners were less likely to get the high-dose vaccine than other Americans, and high-dose vaccine appeared to be less available in communities where more than 20% of the population were minorities.
A decision to give all seniors the enhanced shots isn’t as simple as it seems. For one thing, the CDC’s advisory committee, known as ACIP, hesitates to promote one vaccine over another, afraid that doing so could lead non-touted producers to exit the market and cause vaccine shortages.
In 2017 the advisory committee recommended GlaxoSmithKline’s Shingrix shot over an older shingles vaccine, but even then the committee vote was only 8-7 despite clear evidence of Shingrix’s superiority, notes Dr. Kelly Moore, a professor of health policy at Vanderbilt University who led the Tennessee Department of Health’s immunization program at the time. As committee members feared, Merck took the older vaccine, Zostavax, off the market in the U.S., and for years there were shortages of Shingrix.
Each February, flu vaccine formulas are based on scientific modeling of which strains of the ever-mutating virus will be present the following fall and winter. A mismatch can render the best vaccines nearly powerless to prevent infection, although any vaccine protects somewhat against severe illness. This year’s flu vaccine did almost nothing to prevent infection.
Amid all this uncertainty, many health systems and clinics don’t bother buying high-dose or other enhanced vaccines. It’s complicated to store and administer them separately, physicians say, and patients often get vaccinated at a pharmacy rather than by their doctor. While Medicare will reimburse vaccination with any formula, clinics that end up with leftovers usually have to throw them out — a costlier proposition when the vaccines were more expensive to begin with, said L.J. Tan, chief strategy officer for Immunize.org, a group that promotes vaccination.
For this reason, financially strapped community clinics “try very hard not to waste vaccine doses” and may opt for the simpler, cheaper solution, said Dr. Julia Skapik, a clinician in Virginia who is also chief medical information officer at the National Association of Community Health Centers.
The best comparative study indicates it’s necessary to vaccinate about 220 seniors with the high-dose rather than the standard vaccine to prevent a single case of flu.
Since none of the vaccines have great efficacy in older people, the most important thing is to cocoon the vulnerable by “vaccinating the people around them,” said Martinez, a family doctor in Albuquerque.
“At least until the ACIP decides,” she said, “that seems like a better use of our resources.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation
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