The Journal of American Medical Association (JAMA) has a new article on the relative risks of sexually transmitted infections (STI) for women who either were or were not vaccinated against HPV. The short story is that vaccination is very effective against preventing cancer and has absolutely no impact on the probability that young women will have more sex or at least more risky sex that leads to more STI’s.
— Anupam Bapu Jena (@AnupamBJena) June 16, 2017
The vaccine works and it does not have a side effect that worries people.
I want to talk a little about financing vaccines. Right now, preventative care, including vaccines, is no cost sharing under the ACA. Under the AHCA, who knows what it would be. Vaccines distribute benefits to two groups of people. The first group is the person who receives the vaccine. They get a far lower chance of getting sick. That is extremely beneficial. The second group are the people who are not vaccinated but who avoid getting sick because the transmission vector ran into a brick wall of vaccinated people. This only matters where the disease spreads person to person; it does not matter for diseases like rabies or tetanus.
In the HPV context, that means the young women who are overwhelmingly likely to be HPV vaccinated receive the direct benefit but their lovers and their lovers’ other lovers receive indirect protection. It is a partially a public good. Basic economics argue that public goods that are privately financed will be under provisioned.
The ACA tries to get around this public good problem by mandating that insurers pay for vaccines as a preventative measure. The goal is to reduce the personal expense barrier to getting a partial public good, a vaccine, so that the population is healthier over the long run. It mandates that insurers pay.
The ACA does not mandate that insurers push vaccines hard. With the exception of flu shots, there are very few vaccines that give full benefits that can be internalized by the insurer via lower claims cost within the expected length of stay on a single policy. This is true in all markets. It is especially true for HPV where the health benefits are years after administration. Insurers will pay the claims but they won’t actively chase people to get vaccinated.
If the AHCA passes and if a state chooses to gut essential health benefits, vaccination rates will fall and the population will get sicker over the long run.
Finance is not the only barrier to vaccination. But it is a barrier.