Actions needed to reduce barriers to immunization for adolescents

The Society of Adolescent Health and Medicine releases position statement on the financing of vaccines for this population.

Despite that many vaccines are now recommended for adolescents, coverage rates are significantly lower for this age group compared with vaccines for younger children.

The Society of Adolescent Health and Medicine (SAHM) released a position paper recently that called for improved immunization coverage by reducing financial barriers. More specifically, the society supports three positions. First, is to eliminate financial barriers to make it less difficult for adolescents and young adults to receive routinely recommended vaccines. Second, is to remove financial risk for all providers who serve adolescents, including nontraditional providers, so they can immunize this population without risk. The final position is to increase use of immunization information systems by all providers who deliver vaccines to adolescents and young adults to reduce resource duplication and missed opportunities for immunization.

Taking a stand

Elyse Olshen Kharbanda, MD, MPH, from Health Partners Research Foundation in Minneapolis, Minn., and her co-authors drafted the position statement on behalf of the SAHM Committee on Adolescent Vaccination.

“We are trying to make a strong stand on ways to protect this population,” Kharbanda said in an interview with Infectious Diseases in Children.

Several new vaccines have been recommended for adolescents in recent years. Immunization of adolescents can prevent meningitis, pertussis, influenza, as well as cervical cancer and its dysplastic precursors. Having adolescents in the office for immunizations has the potential to decrease missed opportunities for other preventive health services.

However, each new vaccine for this cohort represents additional costs to an economically fragile and fragmented health care system, the authors wrote.

“Current private sector costs of the newly approved adolescent vaccines range from $37.55 for the pertussis booster, and $103.41 for the meningitis vaccine, to $390.81 for the three-dose human papillomavirus vaccine. This can be an insurmountable barrier for adolescents required to pay out-of pocket for these vaccines,” said the the authors of the position statement.

Section 317 funds have been used by states in the past as a safety net to assist in making vaccines available at reduced or no cost, but these funds are now insufficient to cover the cost of newer vaccines. Therefore, Kharbanda said the SAHM recommends that physicians participate in the VFC program because it allows patients access to care in their medical home and offers a solution to get vaccines at no cost.

“We stand by our position. Our recommendation for expanding VFC is something our society endorses and it may be controversial with others groups, but we are the Society for Adolescent Health and Medicine and our goal is to represent the health care needs of adolescents and young adults.”

However, VFC does not solve all the problems with financing vaccines for this population because administrative fees may not be sufficient to cover overhead expenses associated with these vaccines, even though the vaccines are free. The administrative fees for publicly administered vaccines can vary widely.

Many states are having to cut back on what they offer adolescents and young adults. For practitioners who are purchasing vaccines on their own or part of a group, the SAHM recommend purchasing vaccines collectively, if possible, as a way to potentially lower their out-of-pocket expenses. Pediatricians in a group could work together on both ends and get more group bargaining, Kharbanda suggested.

Participation in an immunization registry would also allow physicians to track immunizations administered in their office. In some areas, she said, immunization registries allow two-way communication and reports immunizations that adolescents may have received in school or other settings.

Health care reform

Patients aged 18 years and younger who are underinsured and patients aged 19 years and older without insurance and are ineligible for vaccines through VFC are most likely to face financial barriers to immunization, according to the SAHM position statement.

Although the health care reform bills of 2010 are likely to increase insurance coverage among young adults, vaccine financing for this age group is not guaranteed, according to the position statement.

“While health care reform seems to be putting a focus on preventive medicine, I don’t think that the reform is going to address all these issues,” Kharbanda said. “Financial barriers are one barrier to immunization, but it’s not the only barrier. Being able to immunize at every opportunity where you see an adolescent, getting adolescents to come in for routine visits, and concerns about vaccine safety are all barriers. There are a lot other areas for improvement but this is an important one.”

Disclosure: Dr. Kharbanda reports no relevant financial disclosures.

For more information:

Kharbanda EO. J Adol Health. 2011; 48:320–321.

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