Considerations for Managed Care Decision Makers Amid Forthcoming Vaccines

In his closing thoughts, Dr Lewis offers considerations for key decision-makers regarding new vaccines entering the marketplace.

James Lewis, PharmD, FIDSA: The decision-making process is fairly straightforward: watch what ACIP [Advisory Committee on Immunization Practices] does. ACIP is so good at being evidence based, casting a critical eye on these data, and then making recommendations. Their recommendations are sometimes a little too conservative, but the best available evidence supports them. As a payer, keeping an eye on what ACIP is doing makes a lot of sense. But certain populations are at high risk. This could mean hematologic malignancy, lung transplant, or liver transplant, where the science isn’t able to keep up because there aren’t enough populations to do the studies that we’d like to see. Hematologic-malignancy populations aren’t huge. For payers, looking at some of the smaller data sets suggests that alternative vaccination strategies in some of these populations can be beneficial. I’m thinking of high-dose influenza in immunocompromised populations, where it is not indicated but makes a lot of sense. The data suggest it’s beneficial. Guidelines from organizations such as the Transplant Infectious Disease Society recommend it. Payers need to stay abreast of some of those issues in this space. It’s not hard. Look at the national guidelines for vaccination in immunocompromised hosts. There are ways to do it, but it benefits payers to keep a hematologic-malignancy patient out of the hospital. There’s no way that ends well. [There are] ways to improve on current vaccines. Sometimes you’ve got to think a little outside the box in some of those spaces.

Foremost in my mind, as we talk about the vaccine space, is the excitement over a couple of new vaccines—particularly RSV [respiratory syncytial virus] and CMV [cytomegalovirus]—that appear to be on the horizon. There’s also excitement over the opportunities for mRNA vaccines going forward. There’s a lot of very cool science there, and this field is moving rapidly. I balanced that excitement with concern over where we stand in society with some of the vaccine misinformation out there. I want to put in a plug for payers, providers, and professional societies to provide ample education opportunities, for not just patients but also frontline health care providers, who are the individuals who have to answer the questions and concerns of these patients. We need to make sure we have a health care provider population that’s able to deal with this. Unfortunately, the questions are becoming more pointed and driven by the internet. Preparing our frontline health care providers to deal with some of those questions is of paramount importance in getting back to the level of vaccine trust that we had before the pandemic.

Transcript edited for clarity.

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