An expert group that provides guidance on U.S. vaccine policy on Wednesday recommended that decisions on the use of two vaccines — one against bacteria that cause pneumonia and one against human papillomavirus — be left to patients and their doctors, stopping short of blanket recommendations from the panel itself.

The decisions by the Advisory Committee on Immunization Practices came as a disappointment to the vaccine manufacturers. But they also keep both products on the official vaccine schedule and covered by health insurance.

The vaccines in question are Pfizer’s Prevnar 13, which protects against pneumococcal disease, and Merck’s Gardasil, which protects against human papillomavirus. In both cases, the recommendations related to the use of these vaccines in adults; the votes do not affect the recommendations for their use in children and teens.

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ACIP, as the committee is known, had previously recommended that all adults over the age of 65 receive a dose of Prevnar 13. That recommendation was adopted in 2014.

But at the time the committee agreed that it might need to revisit the advice because of the effect the vaccine was having in children, who also receive it. In short, older adults were benefiting from the use of the vaccine in small children. With fewer kids sick with pneumococcus, fewer cases in older adults were being seen as well.

Several of the committee members who voted against continuing to recommend Prevnar 13 for all adults 65 and older pointed to what Dr. Peter Szilagyi, vice-chair for pediatric research at the University of California, Los Angeles, described as “the remarkable success of the pediatric program.”

The vote was close, however, with eight members voting to remove the recommendation and six voting to continue it. In a 13-1 vote that followed, the committee recommended what’s known as a “shared clinical decision making” — in effect leaving it up to doctors and their patients aged 65 and older to decide whether they should get a single dose of Prevnar 13.

In a press release, Pfizer acknowledged the decision, and said it will continue to develop its pneumococcal vaccine pipeline.

“Direct vaccination remains the best available tool to help prevent against pneumococcal disease and the revised recommendation emphasizes the importance of the health care professional and patient relationship in shared decision regarding vaccination,” said Luis Jodar, chief medical and scientific affairs officer for Pfizer Vaccines.

The committee also took two votes on Gardasil, the HPV vaccine. The first turned previous — and differing — recommendations for men and women on who qualify for catch-up vaccination into a single policy. With Wednesday’s unanimous vote, catch-up vaccination with the HPV vaccine is recommended for young women and men up to the age of 26 who have not previously received three doses of the vaccine.

Although the Food and Drug Administration recently extended the age indication for the vaccine to allow people aged 27 to 45 to be vaccinated, ACIP did not recommend all people in that age group get the three-dose vaccine. Instead, the committee voted to leave the choice to patients and their doctors.

The HPV vaccine protects against viruses that cause cervical, anal, and other cancers. The primary recommendation for its use is in young people before they become sexually active; the viruses are transmitted sexually.

ACIP recommends that the vaccine be given between the ages of 11 and 12 (though it can be started as early as 9 years old) in both girls and boys. Catch-up vaccination programs were recommended for young women up to the age of 26 who were not vaccinated earlier. The catch-up program for young men was to the age of 21; the vaccine was also recommended for males between the ages of 21 and 26 who have sex with men and those who are immunocompromised.

On the issue of whether to recommend catch-up vaccination for people aged 27 to 45, the committee voted 10-to-4 to leave that decision to patients and their doctors. There would be some people in that age group that would benefit from getting vaccinated, a number of the members noted. A working group that advised the committee noted that recommending vaccination of all adults 27 to 45 would not be a reasonable use of resources.

Several members of the committee also questioned expanding the recommendation to such a large population demographic at a time when there is a global shortage of the vaccine that is slowing its roll out in low and middle income countries which could benefit from its use in young women.

Correction: An earlier version of this story misstated the nature of the vote that panel took on catch-up HPV vaccination for those aged 27 to 45.

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  • More intervention in your life by the medical industrial complex, complete with the revolving doors between the CDC and big pharma. The system is too corrupt to be trusted. The HPV Vaccine On Trial at Amazon…

  • So….their recommendation is “shared decision-making”, which is essentially useless. Thanks SO much for the guidance.

  • I think kids get more than enough vaccines. I was against the HPV vaccine… originally, 3 doses were supposed to be given…then they changed to 2, why and what did 3 doses do to a person that received it? Also, they should be working on a vaccine for lyme disease and herpes since many are infected…. My son did receive it…the 2 doses….

    • The change to 2 doses was based on a different vaccine than the 3 dose. The 3 dose is still being used and offers protection not found either 2 doses . Nothing adverse happened to those receiving 3 doses

      Two Lyme vaccines were developed and not enough people wanted the first one licensed and many who never received it complained loudly about it. It was safe and effective.
      Companies have tried for decades to develop an effective herpes simplex vaccine. It hasn’t been easy or as protective as licensed vaccines. You don’t want more people to get the HPV or adult Prevenar. so why worry about HERPES and Lyme?
      This ACIP wouldn’t know what to do with either of those vaccines.

    • The 2 dose series was based on the studies that continued to be done on the vaccine after it’s initial approval. The antibody response to those boys and girls that received the vaccine beginning at 9-15 yrs old remained higher than those who began the series after 15yrs old . Why did they have a more robust response than the older children? The immune system is just more responsive overall at those younger ages than that of a 16-26 yr old. The schedule change was based on research and not on making the manufacturer more money. This change should give one confidence in the ACIP recommendations being based on science vs economic benefits to the manufacturer.

  • These are some of the same type of people that believe other infectious disease vaccines should be left to a decision between the doctor and the patient. It is not the responsibility of pediatricians to prevent disease in all the age groups because the internists, FPs and othe primary Care docs couldn’t be bothered to do what’s medically indicated. Stop dumping on the Pediatricians!
    We now see what happened with the measles vaccine. How do some of the numbskulls think our influenza vaccinations, etc. fail to reach CDC goals. Well wake up! Unless you recommend it or mandate it you’ll never win. Of course $$ are important, but what’s more expensive or moral, preventing a disease or trying to diagnose and treat it after it has struck a patient for whom a vaccine was indicated? What stupid self-centered decisions that ignore common decency and morality. Let’s encourage the spread of these diseases because some doctor doesn’t understand the seriousness or patient is “afraid” to get a shot.
    The ACIP has failed again and the CDC blew their opportunity to affect the health of the U.S. adult population.

  • Of course the pharmaceutical companies were disappointed. They want any and all of their vaccines to be government-mandated and subsidized.

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