Insured children in rural areas having a hard time getting PCV7

February 2003

BARDSTOWN, Ky. — Many infants in rural communities may not have access to the pneumococcal conjugate vaccine (PCV7, Prevnar, Wyeth) because they have insurance.

In an odd twist on the subject of vaccine access, more advantaged children may in fact be missing out. The reason? Rural communities are mostly served by family practitioners, small town doctors who may opt not to offer pediatric vaccines because of their cost and the volume of shots.

Children without access to vaccines would normally be able to get discounted or free vaccines from their local health department. Due to its high price tag, however, health departments stock supplies of pneumococcal conjugate vaccine only for the Vaccines for Children program.

Herein lies the quandry. Children living in rural communities who have insurance are not eligible for the Vaccines for Children program, so health departments are shutting them out of PCV7.

Here in rural Bardstown, Ky., Stan Block, MD, a pediatrician in private practice, has agreed to front the vaccine to local family practitioners. According to Block, the root of the problem is that many parents in rural communities are only able to get pneumococcal conjugate vaccine if they are willing to travel to a pediatrician’s office that offers vaccines and if they are willing to pay out of pocket. Even those who have insurance coverage for all vaccines cannot receive PCV7 at the health department.

“We’re not realizing the full recommendations of the Advisory Committee on Immunization Practices in most rural settings and some metropolitan settings,” he said.

An expensive vaccine

The pneumococcal conjugate vaccine has many advantages. Studies have shown it to be safe and highly effective in reducing invasive pneumococcal disease. Recent studies have shown that pneumococcal conjugate vaccine is also effective in reducing otitis media and pneumonia.

But, the vaccine is also costly — averaging about $75 a dose. With three to four doses required in an infant series, the total cost per child comes to about $225 to $300.

Before physicians can start giving out vaccines, they must be willing to front a tremendous cost outlay. For some larger practices the price tag for a three-month supply of the vaccine can total up to $90,000.

In smaller, rural settings, the cost outlay is less, but still a disincentive to many family practitioners and pediatricians. For small town doctors administering about $5,000 worth of pneumococcal conjugate vaccine a month, an initial investment of up to $15,000 would still be required.

Insurance companies will reimburse most of the vaccine’s cost to physicians, but repayment can take up to three months. For large practices with two or more pediatricians, the services of a vaccine nurse, as well as a separate immunization room, might also be required. As a result, facility and staff costs have to be factored into this equation as well.

Up to one-third of children in America live in rural areas, but less than 10% of pediatricians practice in rural settings. Some pediatricians who do practice in rural communities do not offer vaccines due to the cost involved. The disparity means some children who should be vaccinated are missing out.

The worst part, Block said, is that these children are being told they are up to date with all of their vaccines. There are no states that require the pneumococcal conjugate vaccine before school entry so as a result, there is no emphasis to catch those children who may have unknowingly missed this vaccine.

“They’re being told that they are fully immunized, but they are not,” he said. “We need to rectify this situation if it’s possible. And if the economics are prohibitive for the government, we need to inform the parents that their children are not being fully immunized as recommended by the AAP and the ACIP.”

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• Dr. Block is a paid consultant and researcher for Wyeth but has no direct financial interest in the products mentioned in this article.