So which approach would you use in your practice? It is something to consider. If ACIP recommends both for initial dosing at 2 months, vaccine buying groups may be making decisions for clinicians based on price and package deals. Regardless, it will further complicate the vaccine schedule. And if it is complicated for us, parents are going to be even less likely to understand if their child is "up to date."
The CDC organized the focus groups to help inform those decisions. One question was "Which type of disease do you think should be given priority when it comes to developing new vaccines?" Choices were those diseases that affect many people but aren’t severe; those that are relatively rare but if contracted can cause severe disability or death; or equal priority for both. The attendees had varied opinions, but 26% in Concord and 59% in Seattle chose the rare/severe option, while 34% in Chicago to 48% in Concord chose "equal priority for both."
They also asked, "How many children need to get a severe illness in a typical year in the United States to make it a good idea that children be vaccinated?" Options were 1 in 100, 1 in 1,000, 1 in 10,000, 1 in 100,000, or 1 in 1 million. While each option was picked by at least some participants, the 1 in 100 option was a frequent choice, ranging from 23% in Denver to 57% in Chicago.
When asked what they believed ACIP should recommend for MCV, most – ranging from 53% in Seattle to 86% in Chicago – chose "add the meningococcal vaccine to the schedule for infants/children, and recommend all children be vaccinated." The other choices were less popular. The "no ACIP or CDC recommendation, but add to the Vaccines for Children program" was chosen by 8%-31%, and "no ACIP/CDC recommendation and do not add to the VFC program" was chosen by 7%-21%.
And as for what they would be willing to pay out of pocket, the largest subset in Chicago (44%) and Concord (53%) agreed to pay the highest priced option for those cities (more than $150), while in Denver and Seattle, 31% and 34%, respectively, actually appeared willing to pay more than $500.
Of course, these are very small samples of likely biased data from subsets of the public having high interest in vaccines (positive or negative attitudes). Still, I think it’s a very interesting new direction the CDC has taken to elicit this kind of information when planning to discuss difficult vaccine policy decisions. At the very least, it improves transparency, which should hopefully help us when talking with our patients about new vaccine recommendations and the complicated schedules, whatever they may be.
Dr. Christopher J. Harrison is a professor of pediatrics and pediatric infectious diseases at Children’s Mercy Hospitals and Clinics, Kansas City, Mo. Dr. Harrison receives grant funding from GlaxoSmithKline for research trials of MMR.