A First World Injustice (a vaccine rant)

The hospital system where I am employed contracts with a major vaccine manufacturer for a two year period in order to obtain discounts on vaccine products.  This is generally a win-win.  The vaccine manufacturer is able to guarantee the sale of lots of product, and the hospital gets a deep discount, improving overall profits.  Our vaccine contract is up this week.

A few weeks ago, our pediatric section had a monthly meeting where the upcoming vaccine contracts were discussed.  The family medicine department is invited to these meetings also, since they also care for children.  Usually, the hospital makes the decision on the vaccines because there is generally a clear direction for cost savings.  This year, both contracts were comparable, so the hospital left the decision to members of the pediatric section.  Only 8 members (out of at least 15 pediatricians and easily 20-40 family physicians) were in attendance, three of whom (including me) came from my clinic.  We currently have a contract with Company A.  We currently use Company A because there was a significant shortage of a vaccine two years ago, and only Company A had that vaccine in adequate supply.  That shortage has been resolved, but now Company A is experiencing another shortage of a combination vaccine that we give to small infants.  Company B also makes a combination vaccine that is used at the same ages.  There is no clear cost advantage between either company, and all the vaccines in question are appropriate, safe, and effective.

We stock two separate chunks of vaccines in our clinic.  There are vaccines purchased by the hospital that are given to private pay patients (for which we bill insurance companies), and another stock of vaccines provided by the government’s Vaccines for Children (VFC) program for children who have Medicaid or who are under or uninsured.  These vaccines are free to those patients.  The shortage of Company A’s combination vaccine only affects the children in the VFC program because our hospital was able to stockpile enough vaccine to cover our existing private pay patients.  The government, being the government, was unable to do the same.  If we renew our contract with Company A, we will have plenty of vaccine for our private patients, but not near enough for our VFC patients.  If we sign a contract with Company B, there’s plenty of vaccine for everyone, regardless of insurance status.

This seemed like an easy vote to me.  I was a little shocked to see my fellow pediatricians from other clinics vote to stay with Company A (5-3).  When asked why, it was because they didn’t want to deal with the hassle of switching.  I should mention also that my clinic sees a significant VFC population, somewhere close to 80%.  These other clinics are predominantly private pay clinics, mostly because of their geographic location in our city.  Our VFC patients won’t miss out on being immunized.  They just won’t have the advantage of the combination vaccine.  So, a private pay patient in our clinic will receive 3 injections at 2,4, and 6 months of age.  A VFC patient will receive 5 injections at each of those visits to obtain the same protection.  I don’t think that’s fair.

My colleagues and I work very hard in our clinic to ensure that our VFC patients are treated no differently than our private pay patients, even when it comes to little things like the number of shots they get at a particular visit.  There are a number of other complicating factors that I won’t go into, but suffice it to say, if we stick with Company A and the shortage, there’s a much higher likelihood that we will make errors in our billing or our vaccine administration, and that places patients at risk.  I won’t tolerate that risk, and neither will my partners.

We’ve filed an appeal with our Medical Staff Office, and we have been told there will be a new vote, by ballots rather than by show of hands at a meeting that no one really has time to attend.  This way, all stakeholders will be represented (including those of the family medicine department who also see a large VFC volume, as we do).  The contract must be signed in two days, and we’ve not seen a single ballot come across our fax machines yet.  I’m worried we’ll end up stuck with Company A simply because time runs out.

I am passionate about vaccines.  There are very few things that have improved the health of children like vaccines have.  I simply won’t compromise on protecting the most vulnerable children in my community.

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