On clarification on "cost effective." Katelyn said correctly that the vaccines given to those 65+ annually are cost effective. However, that does not mean that the vaccines would cost less than the prevented hospitalization. That is "cost saving," a special subset of cost-effective. The ACIP reported that a single dose of COVID vaccination annually for those over age 65 was cost saving last fall, but "only" cost effective (Cost of $11K per QALY) with this Spring's evaluation.
We generally consider interventions cost effective if they cost less than $50K (or $100K or $150K) per Quality Adjusted Life Year (QALY) saved. VERY few things within medical care delivery are cost saving (traditional childhood vaccines, birth control and abortion, as well as flu shots for those over 55, palliative care and smoking cessation. But not much else!). So it's pretty amazing that the these vaccinations are cost effective - though they are not cost saving.
Again, thanks to YLE for all that you do to keep us informed!
You had me at hello with this: "The vast majority (95% of adults) were not up-to-date on their annual Covid-19 vaccine."
Followed by that lovely chart showing only 2-5% of hospitalizations across ALL age groups had received the XBB monovalent vaccine this fall.
Another commenter astutely quoted the vaccine durability looks pretty good through 119 days, but I'm not sure we can say not waning yet, as we are now another 60+days since the end of that period.
With Covid being a systemic disease, and my primary care priority of preventing complications, increased CV risks, long Covid, and problems well beyond the most dire data points of hospitalization and death... I'll be giving the spring boost a thumbs up for my peeps.
My mom is 100, in her own home ( but home bound) in a major city, and we have been trying for months to get her a vaccine. From the hospice, no. From her delivery pharmacy, no. Access for the frail elderly and disabled is terrible, and yet these are the people who need it most.
At my own pharmacy, there have been signs on the doors for months, saying “ we have no Covid vaccine.”
This access issue is another reason even older people aren’t getting vaccinated.
You said that “ I’m not convinced that most people over 65 need a spring vaccine.” If you want to educate people and have them take your advice, show the data to support this opinion so people can make an informed judgement.
Thanks for the update. If a previous infection should count like a vaccine, it seems obvious that one of the major reasons people aren’t getting vaccinated is because they recently had Covid. This reason doesn’t show up in the CDC survey results, perhaps because of how the survey was designed. Many people I know got Covid in late summer/early fall, even before back-to-school.
What this means is we need to get updated boosters out sooner - not September/October.
I think a big reason the numbers are down for getting vaccinated is that it became commercialized and it cost many. I can give you many examples here in Maine where if the vaccine continues to be free folks would have gotten it
Thank you. From a public health perspective, can you explain why the ACIP is not recommending the spring vaccine for those who have comorbidities / are immunocompromised, even if they have not reached the age of 65? And what is the evidence that supports drawing the line at 65 instead of, say, 55 or 60?
Just a reminder on why ACIP might have had to issue a pro forma "should" - because of its statutory role relative to the Affordable Care Act. The only way to guarantee that ACA plans cover vaccines without cost sharing is an affirmative recommendation from ACIP. If you want a compelling reason for ACIP to use "should" versus "may" - there you have it.
Thank you as always for your ACIP Cliff notes, I always look forward to reading your newsletter. I've been run COVID19 vaccine clinics in the metro Boston area since vaccines rolled out in 2021. The biggest difference (we found) between the current 2023-2024 COVID19 immunization season and prior years is the privatization of vaccines and overall cost. While the recommendations mean insurance companies "have to" reimburse for the vaccine, not all insurance companies cover the cost (HMO's out of network won't). The out of pocket cost for the COVID19 vaccine is $170-$190. For those under insured or without insurance, finding a pharmacy that participates in the Bridge Program is challenging. I wish our gov't would cover the full cost of vaccines, this would be so helpful for so many. Thank you again!! p.s. I agree stronger language "should" might be more impactful this spring.
I’ll add my bit regarding “may” versus “should”. The real life consequences of the wording for who should get the adult RSV vaccine resulted in some medical groups requiring (read delaying) vaccinating people in the target group. This affected family members and friends of mine. So I’m all for “should” in the over 65 group.
My husband and I (79 and 78) have had every COVID vaccine dose offered including last fall just before leaving for a tour of Slovenia/Croatia in October. We both got COVID for the first time with symptoms starting two days apart. It was like a very bad cold (him) or flu (me). Both had fevers for 2-3 days. We are traveling to the UK this June. Soliciting opinions on getting another dose in maybe April? Both of us had lingering fatigue and I think it may be persisting for me.
While looking at the impact on hospitalizations is important, it ignores the big issue of long covid. It's been shown that vaccines reduce the risk of long covid. Given the safety of these vaccines for the vast majority, an updated shot every 6 months for the vast majority (including those under 65) would go a long way to prevent more long-covid cases and disability as covid continues to evolve. It would also reduce missed school and work days as it reduces the risk of transmission and severity of illness among those not hospitalized. Hospitalization is not the only important outcome to consider, right?
"Americans over the age of 65 should receive a second dose of the booster shot recommended in September, a Centers for Disease Control and Prevention advisory panel voted Wednesday, noting that the extra protection has likely already begun to wane."
As always, YLE summaries are the best!
On clarification on "cost effective." Katelyn said correctly that the vaccines given to those 65+ annually are cost effective. However, that does not mean that the vaccines would cost less than the prevented hospitalization. That is "cost saving," a special subset of cost-effective. The ACIP reported that a single dose of COVID vaccination annually for those over age 65 was cost saving last fall, but "only" cost effective (Cost of $11K per QALY) with this Spring's evaluation.
We generally consider interventions cost effective if they cost less than $50K (or $100K or $150K) per Quality Adjusted Life Year (QALY) saved. VERY few things within medical care delivery are cost saving (traditional childhood vaccines, birth control and abortion, as well as flu shots for those over 55, palliative care and smoking cessation. But not much else!). So it's pretty amazing that the these vaccinations are cost effective - though they are not cost saving.
Again, thanks to YLE for all that you do to keep us informed!
Thanks for the cliff notes!
You had me at hello with this: "The vast majority (95% of adults) were not up-to-date on their annual Covid-19 vaccine."
Followed by that lovely chart showing only 2-5% of hospitalizations across ALL age groups had received the XBB monovalent vaccine this fall.
Another commenter astutely quoted the vaccine durability looks pretty good through 119 days, but I'm not sure we can say not waning yet, as we are now another 60+days since the end of that period.
With Covid being a systemic disease, and my primary care priority of preventing complications, increased CV risks, long Covid, and problems well beyond the most dire data points of hospitalization and death... I'll be giving the spring boost a thumbs up for my peeps.
Dr. Jetelina,
My mom is 100, in her own home ( but home bound) in a major city, and we have been trying for months to get her a vaccine. From the hospice, no. From her delivery pharmacy, no. Access for the frail elderly and disabled is terrible, and yet these are the people who need it most.
At my own pharmacy, there have been signs on the doors for months, saying “ we have no Covid vaccine.”
This access issue is another reason even older people aren’t getting vaccinated.
Hi YLE! Can you tell us how Novavax compares to the mRNA vaccines in terms of VE and durability? Thanks!
Is there any indication that those under age 65 with health considerations like being immunocompromised can get the vaccine if a doctor recommends it?
Is there any reason not to get the spring shot?
Are you saying that if one got the shot last fall the overall protection it provided has not yet declined?
Can you say more about what a 49% VE means? E.g. did X% get Covid without the shot and .49X with it, and if so, what is X?
Any data on vaccine effectiveness against long Covid?
You said that “ I’m not convinced that most people over 65 need a spring vaccine.” If you want to educate people and have them take your advice, show the data to support this opinion so people can make an informed judgement.
Thanks for the update. If a previous infection should count like a vaccine, it seems obvious that one of the major reasons people aren’t getting vaccinated is because they recently had Covid. This reason doesn’t show up in the CDC survey results, perhaps because of how the survey was designed. Many people I know got Covid in late summer/early fall, even before back-to-school.
What this means is we need to get updated boosters out sooner - not September/October.
So appreciate all you share
I think a big reason the numbers are down for getting vaccinated is that it became commercialized and it cost many. I can give you many examples here in Maine where if the vaccine continues to be free folks would have gotten it
What are your thoughts
Dr. Jetelina,
Thank you. From a public health perspective, can you explain why the ACIP is not recommending the spring vaccine for those who have comorbidities / are immunocompromised, even if they have not reached the age of 65? And what is the evidence that supports drawing the line at 65 instead of, say, 55 or 60?
Just a reminder on why ACIP might have had to issue a pro forma "should" - because of its statutory role relative to the Affordable Care Act. The only way to guarantee that ACA plans cover vaccines without cost sharing is an affirmative recommendation from ACIP. If you want a compelling reason for ACIP to use "should" versus "may" - there you have it.
Thank you as always for your ACIP Cliff notes, I always look forward to reading your newsletter. I've been run COVID19 vaccine clinics in the metro Boston area since vaccines rolled out in 2021. The biggest difference (we found) between the current 2023-2024 COVID19 immunization season and prior years is the privatization of vaccines and overall cost. While the recommendations mean insurance companies "have to" reimburse for the vaccine, not all insurance companies cover the cost (HMO's out of network won't). The out of pocket cost for the COVID19 vaccine is $170-$190. For those under insured or without insurance, finding a pharmacy that participates in the Bridge Program is challenging. I wish our gov't would cover the full cost of vaccines, this would be so helpful for so many. Thank you again!! p.s. I agree stronger language "should" might be more impactful this spring.
Thanks - as always your posts are so informative.
I’ll add my bit regarding “may” versus “should”. The real life consequences of the wording for who should get the adult RSV vaccine resulted in some medical groups requiring (read delaying) vaccinating people in the target group. This affected family members and friends of mine. So I’m all for “should” in the over 65 group.
My husband and I (79 and 78) have had every COVID vaccine dose offered including last fall just before leaving for a tour of Slovenia/Croatia in October. We both got COVID for the first time with symptoms starting two days apart. It was like a very bad cold (him) or flu (me). Both had fevers for 2-3 days. We are traveling to the UK this June. Soliciting opinions on getting another dose in maybe April? Both of us had lingering fatigue and I think it may be persisting for me.
While looking at the impact on hospitalizations is important, it ignores the big issue of long covid. It's been shown that vaccines reduce the risk of long covid. Given the safety of these vaccines for the vast majority, an updated shot every 6 months for the vast majority (including those under 65) would go a long way to prevent more long-covid cases and disability as covid continues to evolve. It would also reduce missed school and work days as it reduces the risk of transmission and severity of illness among those not hospitalized. Hospitalization is not the only important outcome to consider, right?
From the Boston Globe:
"Americans over the age of 65 should receive a second dose of the booster shot recommended in September, a Centers for Disease Control and Prevention advisory panel voted Wednesday, noting that the extra protection has likely already begun to wane."