posted by Chris Regal, Director, Clinical Innovations
on May 22, 2019
Americans are experiencing the worst measles outbreak in over 25 years, and the disease continues to spread. Clinicians, government officials, business leaders, and other stakeholders are stepping up their efforts to promote the use of vaccines. This includes health insurance providers, which remain strongly committed to raising awareness about the importance of immunizations among both children and adults and covering recommended vaccines to protect people of all ages.
As society collectively receives immunization for a particular disease, there becomes a “community immunity.” That means diseases that once killed hundreds, or even thousands, of people, disappear. Polio, for example, was eliminated in the United States in 1979 after the polio vaccine became widespread. Measles was declared eliminated in 2000 after 12 consecutive months without a case of the disease reported.
In the United States alone, approximately 42,000 of the 4.1 million children born each year would die early deaths as a result of diseases that could be prevented with vaccines. The Centers for Disease Control and Prevention (CDC) estimates 21 million hospitalizations and 732,000 deaths will be avoided among children born over a 20-year period (1994-2013) because of vaccines. And measles-related deaths declined by 79% between 2000 and 2014 as a result of more widespread global access to the vaccine, saving an estimated 17.1 million lives, according to World Health Organization estimates.
Vaccinations to children born over a 20-year period will save nearly $295 billion in direct costs, which includes avoided hospitalizations and other medical care, and $1.38 trillion in total costs to society, such as lost wages and decreased productivity, according to CDC data. Across all babies born today, $13.5 billion in direct health treatment costs are prevented over a lifetime with vaccines, a study from Translational Science concluded. The same study also found $70 billion in lost productivity is avoided by preventing diseases with vaccines.
Health insurance providers recognize the importance of vaccines. They are taking steps to increase vaccination rates in children and adults and to stop outbreaks of diseases that vaccines can help prevent. Most vaccines are preventive care under the Affordable Care Act, and are available through private health plans with no cost sharing for patients based on the recommended CDC vaccine schedule. These vaccines include:
For seniors, Medicare Part B covers most—but not all—vaccines Medicare patients may need, including the Hepatitis B vaccine for patients at high or intermediate risk, the influenza vaccine, pneumococcal vaccine, and vaccines directly related to the treatment of an injury or direct exposure to a disease or condition (i.e., a rabies vaccine after a dog bite). Medicare Part D covers other vaccines under individual plan formularies, such as the shingles (Herpes Zoster) vaccine, Hepatitis A and B vaccines for low-risk patients, or the meningococcal vaccine.
Despite broadly available coverage for recommended vaccines, low vaccination rates—particularly for adults—are an ongoing public health problem. Nationwide, approximately 42,000 adults and 300 children die each year from diseases that vaccines prevent.
There are communities in the United States that have either religious or personal objections to vaccines, which leads to large outbreaks. The current measles outbreak has soared to 839 cases. Similar circumstances contributed to a previous outbreak in 2017, which sickened 79 people in Minneapolis, the largest outbreak since 1990. The outbreak hit Minneapolis’ Somali community particularly hard, and a coordinated education campaign was crucial to controlling the outbreak and improving vaccination rates, said Dr. James Nordin of HealthPartners in Minnesota.
To prevent outbreaks, health insurance providers and other stakeholders are educating people who may be skeptic or fearful about vaccinations and inform them about the benefits of immunization and the potential dangers associated with vaccine-preventable diseases. For example, Highmark is dispelling myths about the HPV vaccine among parents and kids, highlighting the vaccine’s safety and importance in cancer prevention.
As measles cases grow nationwide, we stand ready to work across the health care system to get adults and kids vaccinated to ensure everyone has a chance for better health.