Government requirement for vaccine insurance

Under the new health plan, insurers are required to pay for government recommended Advisory Committee on Immunization Practices (ACIP) vaccines. As the Vaccine Ethics blog points out, this increases the influence of the ACIP even further.

This also presents a couple of interesting problems. In 2008 the U.S. Citizenship and Immigration Services (USCIS) incorporated the ACIP recommendations on the HPV vaccine for women seeking to become citizens in the U.S. This decision led to a lot of resistance because the vaccine is not a requirement for women who are already citizens, it's not a vaccine that protects against any airborne contagion, and it's an extremely expensive vaccine. It was also discriminatory. The National Organization for Women (NOW) has a good synopsis of the problem. After much resistance, the requirements were eventually removed, but it shows the danger of giving too much power to the ACIP. After all, these are recommendations, not requirements. On the flipside, insurers are not eager to cover preventive health care, so issuing a federal requirement is not such a terrible thing.

In other countries, such as the Netherlands, research around vaccines has been a government-driven project, rather than a private industry responsibility. Corporations are disinclined to spend money on vaccines because they are not a moneymaker, and ostensibly (though increasingly less often in today's vaccine market) once one's customer gets vaccinated, he or she does not come back for another vaccine. (This is less true with vaccines such as the chickenpox vaccine, which appears to have waning immunity just in time for one to be at risk for shingles. There is now also a shingles vaccine, conveniently preserving or at least extending the market for the manufacturer's vaccine...Chickenpox is an example of an expansion of a market that seems unnecessary.) So the government requirement of insurers is a great way for pharma to insure their vaccines get funded. The U.S. is an important market for pharmaceutical companies and provides the incentive to develop vaccines, since companies can charge a lot for the vaccines here (as long as insurance companies will pay for them), making the vaccines more affordable in countries where there is less opportunity to make money, though often a greater need for the vaccines. There is also the Advanced Market Commitment (AMC) for certain vaccines, which has structured the pricing of vaccines so that countries that have a robust market can help subsidize certain vaccines (including the HPV vaccine) for countries that cannot easily afford the market price.

The new requirement poses an interesting conundrum with the HPV vaccine, as it's recommended for women but does not have recommendations for men, in spite of being FDA approved for men. In this instance, an FDA approval does not actually mean insurers will have to cover it. As has been the case with all sorts of attempts to require the HPV vaccine or to slot it into government regulation, the uncertainty about male vaccination pokes holes at the HPV vaccine's great promise, further revealing its status as a commodity instead of a necessary health intervention.

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