Patients and medical professionals are trying to navigate confusion created by the new federal recommendations for the COVID-19 vaccine 鈥� and health experts are worried it could dissuade people from getting the vaccine at all.
The confusion stems from two agencies with differing recommendations.
The approved the COVID booster earlier this year for anyone who is over 65 or has an underlying condition.
However, the Centers for Disease Control and Prevention鈥檚 . The agency said anyone older than six months can get the vaccine 鈥� they just need to complete what鈥檚 called the shared-clinical decision making process.
It鈥檚 a process a lot of medical professionals already engage in 鈥� like providers at Prism Health North Texas, a system of community health centers.
鈥淚t is not something that's new,鈥� said Dr. John Carlo, an infectious disease expert and Prism鈥檚 CEO. 鈥淚t is perhaps a little different in terms of how this is being discussed for considerations for immunizations. But we've been working under a shared decision-making model for many, many years.鈥�
Catherine Troisi, a professor focusing on epidemiology and infectious disease at UT Health Houston鈥檚 School of Public Health, said despite the simple concept, it could lead to fewer people getting vaccinated.
鈥淵ou鈥檙e supposed to talk to a health care provider and make that decision together about whether to get the vaccine,鈥� Troisi said.
But she said there isn鈥檛 much clarity around what the recommendation looks like in practice, which creates a lot of unanswered questions. For example, Troisi said it鈥檚 not clear if patients must prove they spoke to a medical professional, or who is able to administer the vaccine.
Recommendations raise coverage questions
The CDC鈥檚 recommendations are particularly important for patients with commercial or private insurance, like Affordable Care Act plans and many employer-sponsored health plans.
CDC vaccine recommendations are developed by its , or ACIP.
鈥淚f the ACIP recommends something, then insurance needs to cover it without a copay,鈥� Troisi said. 鈥淚f you go through this shared clinical decision making鈥hen your insurance company is obligated to pay it.鈥�
Because the term 鈥渕edical professional鈥� is so broad, Troisi said interpretation of the recommendation can vary.
鈥淓ven within Houston, I hear my friends say 鈥� they go to one CVS and they're told they can't get it. And in a different CVS they can,鈥� she said. 鈥淭here's just a lot of confusion."
Carlo said he鈥檚 been hearing from patients that they couldn鈥檛 get their COVID-19 shot where they usually do 鈥� in some cases because of uncertainty created for providers.
鈥淥ther centers have not ordered, for example, the COVID vaccine because of the concern about reimbursement and some of the restrictions that may be there,鈥� Carlo said.
While Prism hasn鈥檛 seen many actual denials, Carlo said the possibility of them is enough to cause providers and clinics to be cautious.
How organizations planned with the uncertainty
Jason Vercher, Prism鈥檚 vice president of operations, said planning for annual vaccines was a lot different this year.
鈥淭ypically, we will do a preorder of our respiratory vaccine such as flu and COVID, and we'll do a very large preorder,鈥� he said.
However, Prism didn鈥檛 preorder as many doses of the flu shot as it usually does 鈥� even though the recommendations for that didn鈥檛 change. For the COVID-19 vaccine, Vercher said Prism skipped out on preordering entirely.
鈥淲e actually were late in the game in ordering those vaccines because we weren't sure that we were going to be able to offer them to our patients,鈥� Vercher said.
When Prism did order COVID-19 shots, Vercher said it requested about 70% less than it typically would. The concerns don鈥檛 just affect COVID-19 vaccines. Prism also ordered about 50% fewer flu shots.
Vercher said there were several factors influencing the decision 鈥� namely, how insurance coverage and misinformation and disinformation about vaccines might make more people nervous about getting a vaccine.
鈥淲e were just really hesitant as an organization to be overzealous in our ordering,鈥� Vercher said.
Prism had to be financially responsible, but Vercher said also wanted to make sure these resources were available to patients that relied on the health centers.
There was so much confusion when Prism rolled out the COVID vaccine, employees began providing an 鈥渁dvance notice of benefits,鈥� which outlined a patient鈥檚 financial responsibility if their insurance didn鈥檛 cover the vaccine.
鈥淭hat in and of itself did create a barrier because patients would see the ticket price of that COVID vaccine and kind of have sticker shock,鈥� Vercher said.
However, many clinics are determined to connect people to care that they want or need.
鈥淲e want to make sure that we get you connected to resources,鈥� he said. 鈥淓ven if we don't have those resources available, we will find somebody who does.鈥�
Vercher said his organization works with various community partners, like Dallas County Health and Human Services, to connect patients to care in a way that is affordable and accessible despite the current challenges.
Weight of access concerns
Catherine Troisi, the professor at UT Health Houston鈥檚 School of Public Health , said she and other epidemiologists are worried all of these concerns could deter people from getting vaccinated.
鈥淭he uptake wasn't great before all this confusion,鈥� Troisi said.
Last respiratory virus season, 16.5% of Texas adults received the COVID-19 vaccine by late spring 鈥� below the national average. Providers said fewer people have been getting the vaccine this season, and those who have been getting the vaccine have been getting it later.
鈥淲hat this means is that there will be fewer and fewer people getting vaccinated against COVID,鈥� Troisi said. 鈥淚nevitably that means that we will see more deaths because the vaccine protects you.鈥�
Experts highlighted how vaccines can help reduce the risk of infection and severe health outcomes, such as hospitalization and death. But they also said vaccines are effective as a public health tool 鈥� meaning the chance of an epidemic decreases as more people are vaccinated.
Dr. Varun Shetty, the chief state epidemiologist at the Texas Department of State Health Services, said despite these concerns, people can still talk to their doctor, pharmacist or local health authority about getting a COVID-19 vaccine.
鈥淭he good news is that there's a lot of different places to get [a vaccine]鈥� he said. 鈥淭here's a lot of options in our state and a lot of opportunities to take those steps to protect yourself and your family.鈥�
Experts said now is a good time to get annual shots, like those for COVID and flu, to make sure you鈥檙e protected ahead of the holidays. Shetty said the state is still encouraging Texans to talk to their health provider and take steps to protect themselves.
鈥淲hat's been true for past seasons is true today,鈥� Shetty said. 鈥淭he best way to protect yourself is with vaccines.鈥�
Abigail Ruhman is 四虎影院鈥檚 health reporter. Got a tip? Email Abigail ataruhman@kera.org.
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