US COVID vaccine recommendations sow confusion among doctors, insurers

Health Secretary Robert F Kennedy Jr's intervention in COVID-19 vaccine recommendations without input from a key US CDC advisory panel has sown confusion among physicians and insurers over who should get the shots and whether they will be covered, experts told Reuters.

Kennedy, a long-time vaccine skeptic, in a video posted on social media last week said the government was dropping its recommendation that healthy children and pregnant women should receive COVID shots.

Days later, the Centres for Disease Control and Prevention updated its recommended childhood vaccine schedule online to show the shots could be given to healthy children when parents and doctors agree they are needed. It removed its recommendation that pregnant women should receive the shot.

The moves sidestepped the normal process in which a panel of outside experts to the CDC - the Advisory Committee on Immunization Practices - reviews data in a public meeting and votes on vaccine recommendations. The ACIP recommendations are sent to the CDC director for approval and incorporated in the agency's vaccine schedule, which helps determine insurance coverage under the Affordable Care Act.

"The surprise announcement has created uncertainty for payers and providers about whether the video posting constitutes an official policy change," said Sarah Moselle, a principal at health consultancy Avalere.

Insurers will wait to make coverage decisions until after ACIP makes a recommendation at its upcoming meeting scheduled for June 25-27, according to Robert Popovian, founder of healthcare consultancy Conquest Advisors.

The Department of Health and Human Services overseen by Kennedy said the move was within its legal and regulatory authority and reflects the agency’s move toward clinical-guided decision making, a department spokesperson said.

HHS will continue to rely on the work of expert panels, including ACIP, he said, noting that the committee will be meeting this month. The meeting agenda will be released in accordance with prior practice.

Determinations on coverage are up to insurance providers, the spokesperson said.

The CDC has previously recommended the COVID shot for everyone aged 6 months and older.

'AWAITING CLARITY'

"This whole thing is so murky," said an ACIP member who spoke on condition of anonymity. "It's very unclear whose decision is final."

Infectious Diseases Society of America President Dr. Tina Tan said the conflicting COVID vaccine guidance could cause "significant confusion among medical professionals and the public."

Dr Matthew Zahn, an Orange County, California, public health official at OC Health Care Agency who serves as a liaison to the CDC's advisory panel, said: "We're all awaiting clarity."

"It's going to be important to understand how these vaccines are insured," Zahn said. "Specifically, if ultimately there is a recommendation for high-risk populations to be vaccinated, how that is interpreted by insurance companies and thus, how providers can recommend it."

Zahn expects CDC to clarify its guidance in the weeks ahead, though he could not comment on whether that will be at the ACIP meeting.

On Tuesday, Reuters reported that pediatric infectious disease expert Dr Lakshmi Panagiotakopoulos, a CDC official who helped oversee the expert panel on COVID vaccines, told colleagues she was leaving her post as she was "no longer able to help the most vulnerable members" of the US population.

The American College of Obstetricians and Gynecologists raised concerns on May 27 that the HHS decision not to recommend COVID vaccines during pregnancy would make it harder for pregnant women to get the shot "despite the clear and definitive evidence demonstrating its benefit."

The Affordable Care Act generally requires insurers to cover vaccines that are listed on ACIP's vaccine schedule, according to the CDC's website.

Narrowing coverage without knowing what ACIP recommends could put insurers at risk, Popovian said. "It's a liability," he said, adding that insurers need clarity on what they will be required to cover.

A source familiar with plans for the meeting said the panel is expected to consider and vote on COVID-19 vaccines for the upcoming autumn and winter season, adding that the panel had been leaning toward narrowing its recommendations.

The advisory panel has yet to receive an agenda for the upcoming meeting, the source said, and it is unclear whether Kennedy would override any deviation from his announced policy.