Vaccine business booming for pharma; Financing gaps for uninsured children

While we've been away in August working on the new VaccineEthics.org, a few items appeared that highlighted two very different angles of vaccine financing, cost, and profitability.

Last Sunday's New York Times noted how "Vaccines and Their Promise are Roaring Back." The story highlights the oft-repeated account of the surge in research interest from pharmaceutical companies, new products, and huge profit growth in vaccines in recent years.

Amid all this enthusiasm for new vaccine development, the story all but ignores the many challenges required to produce and deliver safe, effective, and affordable vaccines. Its conclusion captures the tone of the entire story:

"The allure of the silver bullet -- of wiping out an entire class of related diseases with a single injection -- remains a powerful symbol of technological advance. Fifty years ago, vaccine creators captivated the world's imagination. With the return of vaccine-making to the center of the pharmaceutical business, new sources of profits are emerging, and new heroes of innovation."

Speaking of challenges, a report published in JAMA earlier this month noted "Gaps in Vaccine Financing for Underinsured Children in the United States." (subscription required for full text). The CDC-sponsored study offers a useful overview of the varied programs that finance vaccines for uninsured or underinsured children. The authors' data confirm the long-standing belief that a significant percentage of underinsured children are not receiving all recommended vaccines due to shortfalls in state funding and federal discretionary spending. An accompanying editorial by Matthew Davis ("Reasons and Remedies for Underinsurance for Child and Adolescent Vaccines") examines the causes and possible solutions to this problem.

HPV Roundup -- CQ Report, Texas Aftermath, N.H. Success, and More

Another look at recent news and perspectives on Gardasil and HPV vaccine policy appearing in print or online...

• The latest issue of CQ Researcher -- the issue-focused publication affiliated with Congressional Quarterly -- looks exclusively at HPV vaccines and the debate over mandates. The 24-page report is well researched, extensively cited, and offers an incredible range of information as to the scientific, political, public health, and economic considerations in play. It might be the single best source for non-scientists looking to understand 'what all the fuss is about.' Sadly, access requires a subscription to www.cqresearcher.com, but it's likely that readers with university affiliations can access it through their libraries.

• This story in the New Scientist -- US Conservatives Block Cancer Vaccine for Girls -- updates the US state mandate landscape, particularly this month's Texas law effectively overriding Gov. Rick Perry's executive order in February. (More on the Texas legislation can be found here and here. Also, here is the text of Gov. Perry's remarks upon the bill's passage with veto-proof majorities.)

• A major contrast to the Texas saga is what's been happening with Gardasil in New Hampshire, as described in this story from the New York Times: "In New Hampshire, Soft Sell Eases Vaccine Fears." Instead of mandates, the state's practice of voluntary, free vaccination has led to a surge in demand for Gardasil, the story explains.

• We're just about exhausted with op-eds on HPV mandates. At this point, all one hears are the same arguments (for or against) over and over. Here's one that does attempt to say something new, courtesy of The Hastings Center's "Bioethics Forum": In "Choosing Paternalism?", Karen Maschke explores lessons from the U.S. Gardasil experience thus far that might be useful when considering the vaccine's implementation in the developing world.

• Earlier this month, this story in the Washington Post -- "Who Gets Stuck? Doctors, Patients Want Insurers to Pay More for Vaccines" -- looks at some of the reimbursement issues being raised by physicians, particularly the (small) amounts provided for vaccine-related costs beyond the price of the dose itself.