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There are plenty of new vaccines on the market, but for patients to get maximum benefit from them, payers and even physicians need to rethink their roles in prevention.
It's easier to observe change than to enact it. Just look at the field of vaccines: Analysts say the market will grow to $23.8 billion by 2012, but much of the work to make that projection a reality is still on pharma's "to do" list.
Understanding the changing vaccine market is a top priority for Jane Quinn, vice president of vaccine marketing for GlaxoSmithKline. The company is moving forward full-throttle in this arena and is currently awaiting FDA's approval decision for Kinrix, a combo immunization vaccine; a rotavirus vaccine called Rotarix; and cervical cancer vaccine Cervarix. These vaccines face competition—not to mention a changing treatment paradigm. Here, Quinn offers her perspective from inside this dynamic market.
Where do the old ideas about vaccines clash with the new ones?
Vaccines offer a paradox in traditional medicine. It's not a sick person suffering from a disease. You're asking a healthy person to take a medical intervention—and then nothing happens. It's based on proven science, but still requires some faith on their part.
When I was growing up, my mother was told about three vaccines: oral polio vaccine; the diphtheria, tetanus, and pertussis vaccines; and measles. But now, in the first two years of life, a baby can have up to 24 injections—and the cost has increased dramatically. Where a dozen years ago people felt rotavirus or chicken pox were routine childhood illnesses, now we have vaccine solutions for them. And where vaccines used to be seen as being for babies and young children, now they are relevant across a patient's lifespan.
What is payers' receptiveness to covering new vaccines?
There is a very well-developed medical-policy model that exists within the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP). They evaluate the vaccines, and then issue a policy statement that analyzes the breadth of the data and makes recommendations. Medical directors will look to those recommendations for coverage decisions. For example, the Vaccines for Children Program pays for all pediatric vaccinations recommended by ACIP. That can then trigger the private side of the market to cover it.
In general, vaccines offer good cost-effectiveness models, and most pediatric vaccines are well covered, particularly for the Medicaid-eligible population or those with no insurance. Cost-effectiveness becomes less clear when you move into adult immunizations where there is great variability in plan coverage. And there are vaccines, like those for travel, that may be considered discretionary and must be paid for out-of-pocket.
What changes could improve the uptake of vaccines targeted to adults?
The advent of these vaccines starts to force the discussion of whether the healthcare system is ready to adopt prevention into routine coverage. It's still patchy, but the debate is starting to happen. The American Medical Association is having these discussions, and it's invited manufacturers and others into the dialogue.
But it's hard: If you go to the pharmacy, they can run your prescription plan card and see that you have to pay a $10 or $20 co-pay—or nothing. This circumstance isn't the same when you're getting a vaccine in a physician's office. You don't necessarily know your individual plan coverage, which can vary widely from patient A to patient B. There really is no clear payer model.
There are other issues: With the trend toward consumer-driven health plans, will people choose a vaccine, or spend their healthcare dollars elsewhere? What motivates patients to get a vaccine if they're not sick or facing some other reason that pushes them into the physician's office? Are we keeping up high immunization rates so that each generation is protected?
What issue must vaccine manufacturers tackle first?
Pediatricians have become expert at vaccine immunization. But delivering vaccines hasn't been a major part of, say, gynecologists' practice. So one of the big questions is, Who in the healthcare system is ready to become an immunizer—ready to buy, store, and bill for vaccines, ready to do the follow-up for compliance and give patients their second or third shot?
The financing questions are next, and understanding the value of these preventative interventions. We must know what outcome studies are necessary to ensure that payers understand the benefit these vaccines represent.
Jane Quinn is vice president of marketing in GlaxoSmithKline's vaccine business unit and also oversees commercial development activities for GSK's early-stage pipeline. Quinn previously worked for Merck in research and new-product planning. She joined GSK in 2001 as a senior product manager in pediatric vaccines. She was among the first recipients of the GSK Women's Leadership Award.