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State will cut free flu shots by over half

High-risk adults to feel reduction in US aid

By Chelsea Conaboy
Globe Staff / August 30, 2011

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The state will cut the number of free flu vaccines it distributes for adults by more than half this year, sharply limiting the supplies that will be available at local health departments and community health centers.

The cuts, prompted by budget constraints, mean the loss of thousands of doses that have been given in past years to pregnant women, who face higher risks from flu. Doctors said the reductions could make it harder for the uninsured and people who have relied on community flu clinics to get vaccinated.

This represents “a tremendous cut for us,’’ in an era when health officials have been pushing for more people to get vaccinated, said Dr. Anita Barry, director of the Boston Public Health Commission’s Infectious Disease Bureau. “I worry about the people who will fall through the cracks. There will be people who won’t get vaccinated if it’s not very easy for them to do so.’’

But state officials reason that, with a record number of Massachusetts residents covered by health insurers that will pay the cost of the vaccine, residents have other options.

Last year, the state Department of Public Health provided 350,762 doses for adults at no cost, about 34,000 of which were distributed through the Boston commission. This year that supply will be cut to about 140,000. Barry expects to receive fewer than 16,000.

Flu viruses typically begin spreading in the fall. Most flu shots are given by physicians, hospitals, and pharmacies, and are paid for by insurers or directly by the consumer. But the state provides free vaccines for adults who do not have adequate coverage or access to a doctor.

The US Centers for Disease Control and Prevention recommends that everyone over the age of 6 months get a flu shot each year.

Barry’s office has worked over the years with community health centers to vaccinate people who are not motivated to go to the doctor’s office or lack access to one.

The commission trains nurses or doctors to give flu shots, using its state supply, at churches or mosques, for example. Those programs reach people who may be leery of vaccinations but are willing to get one if it is administered by people they know, Barry said. She said it is not clear what will happen to that effort now that her office will have fewer doses.

The state’s supply was cut primarily because federal aid that the state uses in part to pay for adult vaccines is projected to drop about 24 percent this year to $3.9 million, said the Department of Public Health’s commissioner, John Auerbach. And the cost of vaccines rose slightly.

Auerbach said he expects the impact to be offset by the state efforts to expand insurance coverage. “We think it’s a good thing for people to use their insurance card when their insurance card will pay for a service,’’ he said.

Plus, he said, many local health departments are now able to accept insurance to pay for vaccinations.

Massachusetts has one of the most aggressive vaccination programs in the country. For example, it has one of the highest rates of vaccinating teens, according to CDC statistics released last week.

Dr. Lance Rodewald, director of that agency’s Immunization Services Division, said many states are making difficult choices about whom to vaccinate as the list of recommended childhood vaccines grows and the price skyrockets.

Researchers continue to find ways to vaccinate against new diseases, such as human papillomavirus, or to strengthen protections against others. This year, the federal agency is recommending that adolescents get a second vaccine against bacterial meningitis, for example.

Those developments are good for childhood health and save billions in long-term medical costs, Rodewald said, but they make vaccination more expensive.

The total cost of vaccines recommended this year for children through age 18 is $1,620 for girls and $1,332 for boys, compared with a $370 cost for each in 2000, according to a CDC analysis.

States receive full federal funding to vaccinate children who are uninsured, on Medicaid, or American Indian. The program also covers children whose commercial insurance does not pay for vaccines, if those children get their shots at a federally-qualified health center.

Massachusetts is among the states that chooses to do more, buying vaccines for most children in the state and some adults using state money and additional federal funding.

Some of the financial strain is mitigated in Massachusetts by a program requiring health insurers to pay into a fund for purchasing the state supply. The state this year increased its funding for the vaccine program slightly to about $51.4 million, but the department has had to make that money go further, Auerbach said.

The cuts will not affect most childhood vaccines, though the department has said it will no longer provide certain non-routine doses for children who are insured. State supplies will be reduced for adult vaccines in addition to the one against flu: Those for pneumonia, hepatitis A, hepatitis B, whooping cough, and measles will be reduced.

Most adults received a measles vaccination as a child or have a natural immunity. But the United States has seen a surge of measles cases this year, with at least 22 cases reported in Massachusetts since May.

The state ordered about 1,000 adult measles doses this year, down from 4,000 last year, Auerbach said.

“We’re comfortable and confident that we have enough of a reserve centrally and through our relationship with the CDC’’ to address an outbreak, he said.

The state also will no longer distribute flu vaccines directly to obstetric and gynecological practices. Those physicians have seen a surge in interest from pregnant women, who are at higher risk for severe illness from flu, since the swine flu pandemic that began in 2009. Last year, they reported using 11,000 state-supplied doses.

Under a provision of the Affordable Care Act, insurers are required to include the full cost of vaccines in their coverage as they renew plans. But convincing people to get the shot and reaching the uninsured could remain a challenge, Rodewald said.

About 166 million doses of flu vaccine, which includes protection against the swine flu and annual flu strains, are expected to be made this year, slightly higher than last year’s record amount. Rodewald and Auerbach urged people to get vaccinated by a doctor or at the growing number of pharmacies providing the shot.

“There should be plenty of vaccine to go around,’’ Rodewald said.

Chelsea Conaboy can be reached at cconaboy@boston.com.

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