Q&A: How ACIP Changes Could Reshape Patient Care

Kevin W. Cleveland, PharmD, professor at Idaho State University L. S. Skaggs College of Pharmacy, explores the potential impacts of changes to the Advisory Committee on Immunization Practices (ACIP), highlighting concerns about shifting medical guidance and vaccine recommendations. He emphasizes the critical need for health care providers, especially pharmacists, to independently evaluate scientific evidence, maintain open communication with patients, and proactively address vaccine-related concerns. Further, Cleveland underscores the importance of maintaining evidence-based medicine, building patient trust, and ensuring continued access to preventive health care in an increasingly complex medical landscape.

Kevin W. Cleveland, PharmD, urges evidence-based approaches to immunizations in an era of uncertainty. | Image Credit: Drazen - stock.adobe.com

Drug Topics: How will health care providers' trust in federal health entities be affected?

Kevin Cleveland, PharmD: It's going to be pretty significant. I've already had a lot of colleagues of mine...come to me [and say], "Where do we go to get information now?" And...that's a great question, because a lot of things have been removed or...shifted because we do rely on the information from the CDC [and] FDA to actually provide guidance [on] how we treat patients, and even from...guidelines for high blood pressure, and [we rely on knowing] those are experts, and so if you go in and radically change those, it's very difficult to know what to do for patients.

So I think this is going to undermine a lot of our confidence in what recommendations are coming out because we don't know what the process was to put these [new members on the ACIP]. Because if there [are] 8 new members coming on [who] have been appointed, [and] we don't know the process or there [are] some concerns with their background,...what do we have to do as providers? Well, we're going to have to resort to our tried [and] tested process of literature evaluation, and what is the evidence; really, we're going to have to do [or] might have to do some of the work ourselves instead of relying on the experts out there.... We should always be doing that anyway, but I think we're going to have to be more diligent about that. I think the other thing is that we're going to have to rely a little bit more on our associations, such as American Pharmacists Association, American Medical Association, or whatever, to help us navigate some of that and also kind of keep us abreast of evidence-based medicine as well because right now, with what's happening, it's going to be very difficult to really ascertain [whether] this [is]...truly evidence-based or [are these] ideology-driven recommendations.

Drug Topics: What likely effects of this change will pharmacists need to communicate to their patients?

Cleveland: It really comes down to being accessible, and I know pharmacy is very busy. I have family members [who] work in pharmacies in a community setting, and it's always very busy, so it's hard to find the time, but we need to find the time. We need to have those conversations with patients when there's very conflicting information out there and really address [that] from our own perspective because we're just more accessible than most health care providers and...patients can walk right up to the counter and ask a question. It's not like going to the doctor where you have to make an appointment or even [message] the doctor's office, which can take a little bit of time to get to.

So I think really it's just being accessible and available to patients and also providing that information, like I mentioned before, [and] listening and then also providing a very objective perspective [on] what those concerns are. And also, part of it is values, really saying, "OK, yes, I can see why you have those concerns." It's not really validating, but it's recognizing that they have those [concerns], and...dismissing [them] because of the moment...builds a barrier, and then that's going to be even more difficult to overcome. So I think it's really [that] a lot of this is using the resources that we still do have available, and also that the education and communication skills that you do have as a pharmacist will go a long way to actually help the patient navigate that.

Drug Topics: How can a pharmacist explain these changes to a patient worried about vaccine safety, especially if they have heard conflicting messages?

Cleveland: I mean, like I mentioned before, I had a patient or people [whom] I know [who] had questions, and then when I actually explained to them...what's really going on here, and they said, "You're the first one that ever really explained that to us, instead of just brushing it off as a nonconcern type of thing." So I think it's really taking that time, and what I found is that it doesn't take a lot of time, even though it doesn't feel like you have a lot of time, as long as you're very purposeful and targeted and you address those concerns, you can do most conversations and answer questions within just a few minutes as well.

Drug Topics: How do ACIP recommendations affect broader aspects of vaccine access and utilization, such as insurance reimbursement or public health programs?

Cleveland: So I'll start as a provider. We utilize the ACIP guidelines [for] what we recommend [to] patients for preventive care to prevent diseases and things like that [and regarding] what's the best thing. So we utilize that. So in my own clinics that I do,...we are very, very specific. We refer to those as kind of the standard of care...and apply those, and so we're not the only ones, but also insurance companies use that as guidance for whether a vaccine is going to be covered by insurance.... Insurance companies...utilize that information to determine whether they're going to cover a vaccine,...and also the age range, too.

...For example, I mean, [the] shingles [vaccine] was only available for a certain age range, 50 and older, but then...ACIP came out with a decision...that it should also be for [ages] 19 to 49 for people [with] certain medical conditions. Then it was cut. It was also covered. But before that, it wasn't, even though you could see a benefit in that population.... So if things are reversed, if the new ACIP recommendations are changed,...then that could potentially limit access to vaccines for patients, and also because, even though they're FDA approved and things like that, the insurance company doesn't have to [or] won't have to necessarily cover them if they don't want to. So I think it's going to limit access.

It's also going to potentially increase what we're seeing of the vaccine-preventable diseases, especially if they're not part of the recommendations. So we're going to start seeing things change. I mean, to me, it's more [that] access is kind of the bigger issue because I think having access to preventable care is paramount to overall health and well-being because I prefer to focus on prevention instead of being reactive to a situation because if you get sick, then it's more reactive, where we could have prevented it. So I think, hopefully, that kind of answers your question.... [It] is just more [that], to me, it's going to limit access, and then once we do that, we're going to start seeing diseases that we've pretty much not seen, and we're going to start dealing with that. I mean, we're starting to see that with measles down in Texas, where the vaccination rates [are] low in that population...down there. So I think once [vaccines are] not recommended, insurances aren't going to cover them, and some of these vaccines are very expensive, and most people can't afford them.

Drug Topics: Is there anything else you would like to add?

Cleveland: Just more for the health care community, [which] is really, like I mentioned before,...take time to listen to your patients, especially if you don't agree with their questions or viewpoints or things like that, but really have an open dialog with them and still build that trust and still have those conversations, even if they're a little hesitant or resistant to it, because every time you have those conversations, the more open you are about it, and the more you approach it, [the better off patients will be].

So really, as health care providers, we need to...step up and have these conversations when they're very difficult, or even put ourselves out there a little bit to really promote the science behind that because it's one of the things that we should...be doing, [which] is [understanding what] the science [is] really saying here. What is the evidence really saying here? And then, as for policy makers, please utilize the experts out there and...[recognize] that we just need to have a more open dialog instead of just one side or the other. We all have to come together and move forward to actually make a healthy society, and I think we were on that way, but I just hope that we will continue to do that, and we'll have the right people in the right places to do that. But [it] remains to be seen what that will look like here over the next little bit.

READ MORE: Immunization Resource Center

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