"Most of these doctors tended to recommend that children go to a different location for their Prevnar shots," Davis explains. "We know from experience and past research that this fragmentation of care leads to kids' not necessarily getting their vaccines, which is a major reason that VFC was begun. Even though the vaccine would be covered and almost free at most public locations, it becomes an additional barrier to parents, who have to take time off of work or travel a distance for a public clinic."

"Usually we've assumed that doctors are making decisions about administering a vaccine or not on a child-by-child basis," Davis explains. "But for the first time with Prevnar, we're seeing that doctors may be behaving similarly for all children in their practice based on their population. Even if they want to give it, it may be unfeasible if low numbers of children have coverage."

Interestingly, the researchers found that doctors who had treated a child who had suffered a severe illness from a pneumococcal infection -- or who had had a patient who died of such an infection -- were far more likely to say they'd administer Prevnar in their practice, regardless of the proportion of their patients who had coverage for the vaccine.

"The experience of seeing the severe illness these bacteria can cause apparently made them more willing to invest in Prevnar for their practice," says Davis. "But those who had not seen a case of serious pneumococcal disease in at least one of their patients were less likely to say they'd absorb the cost."

Those exceptions to the rule may occur in future, but Davis and his colleagues fear that vaccines now in the pipeline will lead to a replay of the worst aspects of the Prevnar situation. <
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Contact: Kara Gavin
kegavin@umich.edu
734-764-2220
University of Michigan Health System
2-Sep-2003