New, Effective Pneumonia Vaccine for Seniors Finally Gets Green Light

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Screen Shot 2014-08-18 at 3.58.28 PMMedically, it just never made sense. Pfizer s Prevnar-13 pneumonia vaccine works very well in protecting against infection by Streptococcus pneumoniae the most common type of pneumonia, and the leading cause of death for adults 65 and older. (The 13 refers to the number of strains of the bacteria that the vaccine is designed to protect against.)

(Note: The number of deaths from pneumonia is difficult to quantify because the official cause of death is not always accurate. For example, if someone with terminal cancer is hospitalized, develops pneumonia, and dies, the cause of death may be listed as the cancer, rather than the pneumonia itself.)

Additional clinical trials to determine other measures of efficacy are ongoing, but the vaccine was shown to be 46% effective in preventing the first case of pneumonia in the CAPiTA trial (Community-Acquired Pneumonia Immunization Trial in Adults).

Here are the new CDC indications for the vaccine:

  • Adults 65 years of age or older who have not previously received pneumococcal vaccine or whose previous vaccination history is unknown should receive a dose of [Prevnar 13] first, followed by a dose of [Pneumovax] an older pneumonia vaccine
  • Adults 65 years of age or older who have not previously received PCV13 and who have previously received one or more doses of [Pneumovax] should receive a dose of [Pneumovax]
  • The recommendations for routine [Prevnar 13] use among adults 65 years and older should be re-evaluated in 2018 and revised as needed.

(Pneumovax (Merck) is a different type of vaccine that provides protection against the same bacteria. It is considered to be less effective in older children and adults.)

What is a bit strange about the recommendation is why it took so long. The FDA approved Prevnar for children in 2010, and for adults 50 or older in 2011. But, it is the CDC specifically their Advisory Committee on Immunization Practices (ACIP) that determines the scheduling of all vaccines not the FDA. This is where something doesn't quite add up. Despite the 2011 FDA approval for older adults, ACIP refused to vote (for more than two years) on recommending the vaccine for adults. This is significant because once ACIP recommends a vaccine for seniors, it is automatically covered by Medicare.

So, why are two different agencies, both of which are part of the US Department of Health & Human Services (HHS) seemingly at odds with each other?

ACSH s Dr. Josh Bloom has wondered if this wasn't more about money than medicine.

You can read his 2012 New York Post op-ed, The ugly toll of health efficiency, which discusses this exact issue here.