WASHINGTON — Whether or not a child receives at least three doses of pneumococcal conjugate vaccine depends upon the vaccine financing policy of the state he or she resides in, Shannon Stokley and her associates reported in a poster at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.
With a price tag of $51.58 per dose for the federal government and $61.65 in the private sector, pneumococcal conjugate vaccine (PCV7 or Prevnar) is the second-most-expensive routine childhood vaccine (after the new meningococcal conjugate vaccine), said Ms. Stokley, an epidemiologist with the national immunization branch of the Centers for Disease Control and Prevention, Atlanta.
All states receive federal funds to purchase vaccine for children eligible for the Vaccines for Children (VFC) program, which covers all routine childhood vaccines for children who are Medicaid eligible, uninsured, Native American or Alaska Native, and those who are underinsured and receive vaccine at a federally qualified health clinic.
States have the ability to use other state and federal funds to purchase additional vaccine for children who aren't VFC eligible. But because PCV7 is so expensive, some states have specifically excluded it from that additional coverage, she said.
Data were analyzed from the 2001–2003 National Immunization Survey for children aged 19–35 months living in 34 states plus one city with the following vaccine financing policies:
▸ VFC only (Ala., Colo., Ind., Iowa, La., Miss., Neb., N.J., Ohio, Ore., Pa., Tenn., Wis.). Supplies only VFC vaccine to all VFC-enrolled providers. Public health clinics may provide all vaccines to all children who present for immunization.
▸ VFC and underinsured (Ariz., Fla., Ga., Md., Mich., Minn., N.Y., S.C., San Antonio). Supplies all vaccines for VFC-eligible and underinsured children to all VFC-enrolled providers.
▸ VFC and underinsured-select (Ill.). Supplies all vaccines for VFC eligible and all vaccines except PCV7 for underinsured children to all VFC-enrolled providers.
▸ Universal (Ark., Idaho, Mass., Maine, N.H., N.M., R.I., Wash.). Supplies all vaccines to all providers.
▸ Universal-select (Conn., Nev., S.D., Vt.). Supplies all vaccines except PCV7 for children who are underinsured or fully insured, to all providers.
Overall, the proportion of children who received one or more doses of PCV7 rose from 37.3% in 2001 (the year after it was licensed) to 88.5% in 2003. The proportion receiving at least the first three doses rose from 6.7% in 2001 to 69% in 2003.
The likelihood of receiving three or more doses of PCV7 for children living in universal purchase states was 1.73 times greater than for children living in universal-select states, while the odds of receiving three or more doses of PCV7 for children in the VFC and underinsured states (plus San Antonio) were 1.06 times higher than for children in the VFC and underinsured-select states, Ms. Stokley and her associates reported.
After adjustment for child and provider factors, children living in universal-select or VFC and underinsured states had significantly lower odds of receiving three or more doses of PCV7, compared with children living in VFC-only states.