Although the telltale signs of fall are already approaching – leaves changing, a chill in the air, kids going back to school – one harbinger of the season might look a little different this year: vaccine recommendations.
While health care decisions are deeply personal for each person and family, annual vaccination guidance provided by medical experts at the Centers for Disease Control and Prevention is used by many people and their medical providers as a resource for understanding the severity of various diseases as we enter the time of year when people may be more vulnerable to them.
This year, changes in leadership at the CDC, including the panel of physicians that make recommendations about immunization practices, have delayed the release of its annual vaccine schedule. Combining this with ongoing political debate, a new spotlight on guidance from medical groups and questions about vaccine availability in each state makes for a challenging landscape for patients to navigate this fall. Here to sort much of this out for the Drexel News Blog is College of Medicine Professor Jennifer Hamilton, MD, PhD, who regularly teaches students, researches and advises patients about immunization.
Among other roles delving into studying vaccines and vaccine hesitancy, you’ve served as a member of a working group for the Advisory Committee on Immunization Practices, and a vaccine science fellow with the American Academy of Family Physicians. How does this work play a role in your current responsibilities?
I see patients of all ages at my clinical office in Manayunk. I might talk about the measles vaccine with the parents of a toddler, then discuss the typhoid vaccine with an adventurous 25-year-old traveler, then go over the importance of getting a whooping cough vaccine during pregnancy with a 30-year-old who is coming for preconception counseling, or talk with a 57-year-old about the shingles vaccine – all during a single day.
I also helped design a simulation used in the third-year family medicine clerkship, where students discuss immunizations with a cautious parent who isn’t sure what’s best for their newborn daughter. The students meet with a standardized patient playing the role of the parent in a video interview. I also give lectures on immunizations.
What impact do you anticipate the shift in communication about vaccines will have on vaccination rates this fall?
The biggest areas of disagreement right now are COVID shots for children, and in vaccinations during pregnancy. Under law, private insurance has to pay for all CDC-recommended vaccinations; a program called “Vaccines for Children” helps families without other coverage get immunizations. Again, all CDC-recommended vaccines are paid for, even if the recommendation is at the “shared clinical decision-making” (sometimes called the “ask your doctor if this vaccine is appropriate for your child”) level.
As of September 10, the recommendation for the COVID vaccine for healthy children starting at age 6 months is at that shared-decision level. So, the vaccine should be paid for, but the discussion with parents may become more complicated.
The CDC recommendation for COVID vaccination in pregnancy was withdrawn entirely. Insurers now may choose to pay for it, but they are no longer mandated to.
I’m telling my patients that the evidence for these vaccinations hasn’t changed. Immunization is still the best tool we have to keep children from needing to be hospitalized for COVID.
The Food and Drug Administration approved the next round of COVID shots for the fall — but only for adults 65 and older, as well as for kids and adults with at least one medical condition that puts them at risk of severe illness. What effect do you think this may have?
The death rates from COVID are no longer nearly as terrifyingly high as they were in 2020 and 2021. Even so, last year, CDC statistics cited more than 47000 deaths from COVID. In addition, “long covid” can result in substantial disability, and vaccinations are one of the best tools we have to prevent that.
I’m not worried about the people who responded to the CDC’s changed recommendations by scouring the rather long list of medical conditions to find a diagnosis that would allow them to get the vaccine. (“Inactivity” seemed to be a favorite in the social media postings I saw.)
I’m much more concerned about the people who go to their local pharmacy to get shots every autumn. This year, if they’re under age 65, they’ll be asked whether they are at high risk. Many people who feel healthy will say “no,” go home without a COVID shot, and think no more of it – even if they have asthma, or high blood pressure, or obesity, etc.
Various medical advocacy groups have offered their immunization recommendations this fall, does it seem like they are coordinating to make these recommendations to build some consensus?
As of September 2nd, it seems like the different groups have been making recommendations without really coordinating. So far as I know, the American College Obstetricians and Gynecologists didn’t check in with American Academy of Pediatrics about the recommendation for covid vaccination during pregnancy, even though pediatricians can take care of pregnant teens. I expect that in the next few weeks, there will be efforts to bring these piecemeal decisions together under some umbrella group.
The pandemic is over, but SARS-CoV-2 is still around, plus flu season, etc. Is it really still important for people to check with their primary care providers to see which vaccines can protect them? What do you wish more people understood about vaccines?
The era of lockdowns is over, but COVID is still killing over 45,000 people a year and leaving hundreds of thousands with persistent fatigue, “brain fog,” breathing difficulty, heart rhythm problems and more. I wish people realized just how useful it is to show your immune system a “wanted poster” before the “bad guys” come to town.
I wish more people knew that measles resets the immune system, leaving people vulnerable to germs that they had encountered before all over again – and that vaccines can prevent that. I wish that people knew that shingles increases the risk of heart attack and dementia – and promising data suggests the vaccine that was introduced a few years ago prevents those complications. I wish that people remembered that cervical cancer used to kill as many women as breast cancer does today – and now we have a vaccine we can give decades before the cancer has a chance to develop.
I wish people understood that diseases that came around in epidemics are still lurking out there today, that there are still deaths from whooping cough and measles, and that we have a way to keep those deaths from happening – but only if we use it.
