Commentary: Clarify policy on pneumococcal vaccine for adults

The CDC’s immunization committee needs to strengthen its vaccine recommendation for older adults.

By Martha Peppones

For The Herald

What if I told you that Washington state, home of a recent measles outbreak, could experience another vaccination scare from the No. 1 cause of serious illness worldwide?

Unfortunately that’s exactly what’s at stake this June, when board members from the Advisory Committee on Immunization Practices (ACIP) will make a decision that could restrict access to vaccines aimed at preventing the spread of pneumococcal disease for adults aged 65 years or older.

Yes. You heard that right. ACIP — a division of the Centers for Disease Control and Prevention (CDC) charged with determining whether physicians are required to recommend vaccinations for infectious diseases — may decide that the current pneumococcal recommendation for older adults no longer needs to be required.

You’d think this is a joke, right? Well it’s not.

As the director of nutrition and advocacy at Homage Senior Services, my work is aimed at enhancing the quality of life for older adults.

I do so by running a number of “Living Well” workshops and support services for older adults struggling with chronic conditions and illnesses, as well as for older individuals simply looking for tips on how to live their best and healthy life.

One of the most consistent recommendations I make to alder adults, who are more susceptible to illnesses at their age, is that they continue to vaccinate against infectious diseases. This is especially the case for the pneumococcal disease, also referred to as pneumococcus.

Simply put, the side effects of pneumococcus are awful and highly contagious. They can cause a variety of illnesses like pneumonia, meningitis and ear and bloodstream infections.

The disease can also be very deadly.

According to National Foundation for Infectious Diseases, there are nearly 1 million adult cases of pneumococcus in the U.S. each year, and 5 percent to 7 percent of those patients die from the disease. Moreover, 18,000 adults aged 65 years or older die each year as a result of the infection.

Fortunately there are two highly effective vaccines currently available for adults aged 65 or older. These are proven to help protect individuals against some of the more than 90 types of pneumococcal bacteria.

These vaccines are highly recommended by ACIP, so much so that physicians are currently required by the committee to recommend them to patients. This is also known as a “full recommendation.”

This, however, could change.

Dr. Nancy Bennett, immediate past chairwoman of ACIP, recently acknowledged that changes in committee recommendations can lead to confusion among providers. This is especially the case when vaccines are labeled as a “clinical decision-making recommendation,” which leaves more room for interpretation because of their increasing complexity and specificity.

In fact, a recent survey of physicians revealed that 59 percent found clinical decision-making recommendations difficult to explain to patients, and only 24 percent were able to identify the definition of a clinical decision-making recommendation.

In other words, a physician might not tell a patient about the pneumococcus vaccine because of vague and confusing guidance. Or not even recommend the vaccination at all. This is concerning given that provider recommendations have been strongly linked to a patient’s decision to receive a vaccine altogether.

On June 26, ACIP will decide the fate of the pneumococcal recommendation in Atlanta, Georgia. Ahead of this meeting, anyone from the general public can submit a written comment by visiting www.regulations.gov and referencing docket number CDC-2019-0028.

I hope that we can all come together on behalf of older adults across Washington and let ACIP know that anything but a “full recommendation” for the vaccine is unacceptable.

After all, hasn’t our state already experienced enough when it comes to preventable disease outbreaks?

Martha Peppones is the nutrition and advocacy director at Homage Senior Services. She lives in Lynnwood.

Correction: The headline for an earlier version of this commentary misidentified the type of vaccine being discussed. The vaccine is for pneumococcal disease.

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