That said, the vast majority of immunizations still take place in physician offices
Editor’s Note: Bill Smith, president of Main Street Vaccines (MSV), discussed the vaccine market with Repertoire in the following article. He has over 18 years of experience in the vaccine industry and has held key positions in corporate management, account management, and marketing. MSV, an NDC Company, is a physician buying group servicing approximately 7,500 physicians across the nation.
Repertoire: It’s July, which means it will soon be back to school for many people. How does a successful distributor rep prepare for the season? How does he/she prepare their customers for it?
Bill Smith
Bill Smith: Back to school is certainly a very busy time for offices that immunize. To prepare, I would recommend that all distributor reps review the immunizations schedules on the Centers for Disease Control and Prevention (CDC) website, particularly the Child and Adolescent Immunization Schedule, as well as the Adult Immunization Schedule. Distributors can print the schedules and see what vaccine is recommended by age. This will help reps work with offices on needed vaccines by age group within the office.
Repertoire: What – if anything – will be different about Back to School 2019 versus Back to School 2018 or 2017? How will that affect distributors?
Smith: There will not be much difference in this back-to-school season compared to previous years. A key area to work with offices on is the completion of needed adolescent vaccines. For example, the second dose immunization rate for meningococcal A, C, Y, W135 vaccine remains relatively low for 16-18-year-olds, and this patient population is about to enter peak risk for potential exposure to the disease. Working with offices on solutions to help complete the meningococcal series is important to public health.
Repertoire: Today, vaccinations are administered at retail clinics (CVS, Walgreens), grocery stores, etc. How has this affected physicians? How are they meeting the challenge? And how are successful med/surg distributors dealing with this challenge?
Smith: This has certainly had an impact on physicians that immunize the adult population. However, I prefer to view this not as a challenge, but rather another access point to receive immunizations. Most notably, influenza vaccines and a few other adult vaccines are heavily promoted in pharmacies and grocery stores. The vast majority of all immunizations still take place in physician offices, providing excellent sales opportunities for distributor reps.
Repertoire: What is on the horizon for childhood vaccinations?
Smith: In general, there are a lot of exciting developments for vaccines in the coming years and decades. First off, in December 2018, the FDA approved Vaxelis (diphtheria and tetanus toxoids and acellular pertussis adsorbed, inactivated poliovirus, haemophilus b conjugate [meningococcal protein conjugate] and hepatitis B [recombinant] vaccine) which is a pediatric hexavalent vaccine. This vaccine is the first of its kind in the United States and is indicated for the active immunization in children who are 6 weeks old through 4 years old. Additionally, there are currently over 200 vaccines in clinical trial development in the United States targeting many diseases and age populations. The current and future state of vaccines remains a significant factor in public health worldwide.
Repertoire: What can you tell us about expected availability of influenza vaccine for the 2019-2020 season? What are manufacturers telling you? How will this upcoming flu season differ from those of the past, say, five years?
Smith: Currently, it looks like there will be ample supply of the influenza vaccine for clinicians to immunize their patients during the upcoming flu season. In the last several years, there has been more supply than demand, providing plenty of opportunity for patients to get immunized. For the upcoming season, we will have to wait and see how it unfolds. It is always interesting to see which strain predominates disease activity and if activity is high, low or on par with the national baseline throughout the season. From Oct. 1, 2018, through April 27, 2019, the CDC estimates that there were between 37.2 million and 42.7 million flu illnesses, along with 36,100 to 59,600 deaths. Comparatively, the CDC estimated 48.8 million flu illnesses and 79,400 deaths during the 2017-2018 season.
Repertoire: CDC recommends that all 11-to-12-year-olds be vaccinated with a meningococcal conjugate vaccine, with a booster dose given at 16 years old. All teens may also be vaccinated with a serogroup B meningococcal vaccine, preferably at 16 through 18 years old, according to CDC. What are your customers (either physicians themselves or NDC members) telling you about the demand for these vaccines?
Smith: There is a lot of demand for both meningococcal vaccines (ACYW135 and B). Since the meningococcal vaccines are given in a series, there is great opportunity for distributor reps to work with offices on solutions to complete each series. Disease education and reminder and recall systems to bring patients back have been successful ways of helping patients and their parents see the importance of completing the series for each vaccine.
Repertoire: The CDC reports that HPV infections and cervical pre-cancers have dropped significantly since the vaccine has been in use. HPV types that cause most HPV cancers and genital warts have dropped 71% among teen girls. What are your physician members or NDC members telling you about the demand for these vaccines?
Smith: Our members report that demand from healthcare providers for the HPV vaccine remains high. These figures are a true testament to the value of vaccines and achieving high immunization rates so we can work to prevent disease. This is not just for the HPV vaccine, but for all vaccines in general.
Repertoire: As of May 10, the CDC reported 839 individual cases of measles in 23 states – the greatest number of cases reported in the U.S. since 1994. Has the publicity about measles affected demand for MMR vaccines? If so, how?
Smith: It will be difficult to quantify demand; however, with the CDC, the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) all recommending immunization, we can expect demand to be high. The CDC recently developed an effective toolkit for healthcare providers to have meaningful conversations with parents about this and vaccines in general. The toolkit and more information can be found here: https://www.cdc.gov/measles/toolkit/healthcare-providers.html
How should a doctor respond?
Given the current press about anti-vaxxers, your physician customers may be asked some challenging questions about vaccinations during this ‘back to school’ season.
Parents may question their pediatricians’ recommendations, but that does not necessarily mean they will not accept vaccines, says the Centers for Disease Control and Prevention. After all, parents often consider their kids’ doctor the most trusted source of information when it comes to vaccines. Sometimes parents simply want answers to their questions.
Parents may ask: Can it harm my child to get several vaccines at one time? Does my child need all of the vaccines recommended? To respond, the doctor can:
- Share that no evidence suggests that receiving several vaccines at one time will damage or overwhelm a healthy child’s immune system.
- Explain what antigens are (parts of germs) and emphasize the small amount of antigens in vaccines compared to the antigens babies encounter every day in their environment.
- Remind parents that they must start each vaccine series on time to protect their child as soon as possible, and their child must complete each multi-dose series for the best protection. There are no data to support that spacing out vaccines offers safe or effective protection from these diseases.
Parents may ask: Are these diseases that dangerous? Is it likely that my baby will catch this disease? Will ingredients in vaccines hurt my baby more than possibly getting the disease could? To respond, the doctor can:
- Share his or her experience of how these serious diseases still exist and explain that outbreaks still occur in the U.S. For example: From year to year, measles cases in the U.S. can range from roughly less than 100 to a couple hundred. However, in 2014, health departments reported cases in 667 people from 27 states. Between 1970-2000, health officials reported fewer than 8,000 cases of whooping cough each year in the U.S. But since 2010, health officials have reported between 15,000 and 50,000 cases of whooping cough each year to CDC.
- Teach parents that diseases eliminated in the U.S. can infect unvaccinated babies if travelers bring the diseases from other countries.
- Remind parents that many vaccine-preventable diseases can be especially dangerous for young children, and there’s no way to tell in advance if their child will get a severe or mild case. Without vaccines, their child is at risk for getting seriously ill and suffering pain, disability, and even death from diseases like measles and whooping cough.
Parents may ask: I’ve heard some parents say their child’s behavior changed after vaccines. How do you know vaccines don’t cause autism?
Many rigorous studies show that there is no link between MMR vaccine or thimerosal and autism. If parents raise other possible hypotheses linking vaccines to autism, doctors should:
- Offer patient and empathetic reassurance that they understand their infant’s health is their top priority, and it also is the doctor’s top priority, so putting children at risk of vaccine-preventable diseases without scientific evidence of a link between vaccines and autism is a risk the doctor is not willing to take.
- Share that the onset of autism symptoms often coincides with the timing of vaccines but is not caused by vaccines.
- Give their personal and professional opinion that vaccines are safe.
To view “Preparing for Questions Parents May Ask about Vaccines,” go to https://www.cdc.gov/vaccines/hcp/conversations/downloads/prepare-infants-508.pdf