First the good news: President Trump signed into law last week an expansion of medical coverage for certain premature babies and newborns. The expansion will cover 5,000 additional infants who require special monitoring because of exposure to drug and alcohol addiction, fetal alcohol syndrome or other chromosomal abnormalities. A significant percentage of these babies are born to moms in the U.S. who drink alcohol or are abusing heroin or other drugs.
Now we have the bad news. The Medical Group Management Association (MGMA) expects the new law to delay inoculations for many children for several months, by which time flu, pneumococcal and other pertussis-preventable diseases could be back at epidemic levels. MGMA expects the parents of about 250,000 children eligible for the lower fees to leave their children out of the program, a reality that could lead to a spike in those diseases, at a time when the Centers for Disease Control and Prevention (CDC) anticipates a significant spike in cases this season.
Specifically, MGMA projects that the delayed program will affect about 145,000 vaccinated children who were slated to get the pneumococcal vaccine. Those children are currently at the ages of 3 to 11, so parents who hold those vaccinations in high regard should think twice before removing their children from the program. It is possible the new vaccine could have an effect on those children that wasn’t noticed, particularly if parents notice those children become sick in the next few months. Given the resistance to using vaccines among parents, kids could even be left entirely vulnerable.
What are these children at risk of catching? They are children who receive their first inoculation under this law, which goes into effect in January 2019. The vaccine, known as the Menactra 9 vaccine, protects against nine diseases including pneumonia, meningitis, syncovirus, and the most virulent type of pertussis: toxoplasmosis. These diseases and others are highly contagious, including the newly identified, highly contagious but rare group inoculation. So if a child is left out of this program, those parents could very well be putting children at risk for diseases the CDC says can be prevented with vaccination.
What will this mean for children who are already vaccinated? The CDC has also recommended that children aged 9 to 12 receive the meningococcal vaccine. All older children who have received the meningococcal vaccine must be re-vaccinated every 3 to 4 years. And since many older children are already vaccinated with the B strain (which cannot be treated by a nasal spray), they are unlikely to need to be re-vaccinated. On the other hand, children will need to receive another dose of the meningococcal vaccine between ages 11 and 12 if they received the B vaccine while they were a baby.
Luckily, the CDC now recommends that parents who are in state health plans with covered vaccinations send written notification to their health plan, making them aware that they must leave their children out of the Medicaid Tricare Waiver Program for the new vaccination. That notification is required as part of the early access program. The CDC reported this month that, since September 2018, 566 children have been excluded from the waivers for medical reasons. If any of those children have medical issues that require the flu, pneumococcal or other vaccine for chronic medical conditions, then even if their parents don’t follow through with the written notification, they will be allowed to be excluded again in six months.
As Dr. Betsy Underwood, head of the HHS’ National Center for Immunization and Respiratory Diseases (NCIRD), wrote in a recent editorial: “It would be a shame to leave out young children who were immunized for meningococcal disease and who could be placed at risk for infection. These children should not be left unprotected against vaccine-preventable disease.”
The lack of notification can pose a serious risk to these children’s health, especially if their parents decide not to follow through. The good news is that vaccine-preventable diseases like influenza, whooping cough and pertussis should not be on the increase this year, and can be prevented with vaccination. But families who will never receive the notice can be safeguarded by sending the doctors and hospitals notices that they will be excluded.
Mike Doherty is vice president of the Medical Group Management Association.