Post-COVID Conditions: Information for Healthcare Providers

This COVID Vaccine Program Offered A 'bridge' To Uninsured Adults, And Then The Funding Crumbled

Uninsured adults will lose an option this August to get vaccinated against COVID for free, weeks before an updated vaccine is expected to be released going into respiratory virus season.

Launched in 2023 by the Centers for Disease Control and Prevention, the Bridge Access Program began as a way to connect U.S. Adults with little to no health insurance to COVID vaccines. It was set into motion just as those vaccines shifted from federal administrators to commercial markets, which complicated access for many who had previously enjoyed more freedom over where they received their dose.

Rather than anyone being able to get a free shot wherever they could get an appointment, people with health coverage can seek out COVID vaccines at sites approved by their insurance plans – or pay out of pocket.

Raynard Washington, who serves as health director for Mecklenburg County in North Carolina, said the rollout of COVID vaccines earlier in the pandemic demonstrated a "wonderful example of equity in health" because "it wasn't an issue of cost."

But the end of federally covered access to COVID vaccines last fall suddenly placed doses out of reach for millions of people without insurance or adequate coverage. In 2022, 26 million Americans – about 8 percent of the U.S. Population – were estimated to have no health insurance, according to the Peter G. Peterson Foundation.

In and around Charlotte, North Carolina, more than one in 10 residents lack health insurance, Washington said. He saw how the Bridge program helped uninsured individuals receive vaccines that protected them against the risk of developing severe COVID infections after the pandemic public health emergency ended.

North Carolina's expansion of Medicaid last December also helped connect people to the health care coverage they needed, but "there's still a number of adults who will be left out," Washington added.

READ MORE: How uninsured adults can still get vaccinated against COVID

Since September, more than 1.4 million COVID vaccine doses have been administered across the country through the Bridge Access Program, including to more than 812,000 people without insurance, according to an email between a CDC spokesperson and a CBS News reporter. It was modeled after the successful Vaccines for Children program, which began in 1994 in response to a measles epidemic and has prevented roughly 30 million hospitalizations and hundreds of millions of illnesses, according to CDC estimates.

But in March, congressional negotiations over the nation's budget translated to $4.3 billion being rescinded from the Department of Health and Human Services in COVID supplemental funding. This move prematurely ended the Bridge program, which was already set to expire in December and would have covered vaccines for one more respiratory virus season this fall. Now the program will run out of funding in August.

State and local public health departments are looking for ways to step in, but these are the same institutions that have been chronically underfunded for years going into the pandemic. Now that COVID-related funds have dried up, those same departments have even fewer resources to draw upon.

"It speaks to the importance of moving toward universal vaccines."

Without the Bridge Access Program, Washington said, "We don't have adequate resources locally to purchase vaccines for all who are uninsured."

"It speaks to the importance of moving toward universal vaccines," he said.

Federally qualified health centers may also be able to step in, and a pool of federal dollars referred to as infrastructure funds in the Section 317 Immunization Program could help narrow the gap, said Chrissie Juliano, executive director of the Big Cities Health Coalition. These funds are designed to improve vaccine access, safety and effectiveness and can cover outreach and related programs, but they cannot fix everything.

"We need to think creatively, and we need to bring vaccines or other preventive services to the people who need them the most," Juliano said.

HPV Vaccines Associated With Lower Cancer Risk In Younger Adults

ConferenceASCO Annual Meeting

When compared with unvaccinated patients, HPV vaccines were associated with lower rates of HPV-related cancer for people younger than 40.

People younger than 40 who received a human papillomavirus (HPV) vaccination saw lower rates of cancers often caused by HPV, such as oropharyngeal and cervical cancer, according to findings of a retrospective analysis.

Data presented at a press briefing ahead of the 2024 ASCO Annual Meeting showed that vaccinated female patients experienced statistically significant lower rates of all HPV-related cancers and cervical cancer compared with unvaccinated patients. Differences in the rates of vulvar/vaginal cancers and head and neck cancers did not reach statistical significance, and data for anal cancer were not sufficient for analysis.

Study highlights: HPV Vaccination Associated With Reduced Cancer Risk: The study shows a significant decrease in HPV-related cancers among younger adults who received the HPV vaccine. This highlights the effectiveness of vaccination in preventing these cancers. Reduced Rates of Cervical Cancer: The study found a 63% to 87% reduction in cervical cancer risk depending on the age of vaccination. This is a promising finding for the prevention of this particular cancer. HPV Causes Various Cancers: HPV is not just associated with cervical cancer. It can also lead to oropharyngeal cancers (cancer of the back of the throat), vaginal, vulvar, penile and anal cancers. Vaccination Recommended for Younger Adults: The CDC recommends HPV vaccination for males and females between 9 and 26 years old. Vaccination is also recommended for adults up to the age of 45 in certain circumstances.

In male patients, statistically significant lower rates of all HPV-related cancers and head and neck cancers were observed for vaccinated patients versus unvaccinated patients. Data were not sufficient to analyze the rates of penile and anal cancers.

"Our study showed that patients under the age of 40 [who] were vaccinated for HPV could have lower rates of cancer that are typically caused by HPV, including oropharyngeal cancer and cervical cancer," Jefferson DeKloe, a medical student at Western Michigan University in Kalamazoo and a research fellow at Thomas Jefferson University in Philadelphia, said during the press briefing.

HPV is known to cause cancers in the oropharynx and cervix, as well as in anal and genital regions. HPV vaccines have demonstrated the ability to prevent this infection, and they are recommended for males and females between 9 and 26 years of age. Additionally, patients between 27 and 45 years of age can also receive this vaccine. However, the rates of HPV vaccination in the United States are lower compared with the rates of vaccination for other communicable diseases.

To further study the rates of HPV-related cancers in vaccinated and unvaccinated individuals, DeKloe and colleagues conducted a retrospective analysis using data from the TriNetX Database's US Collaborative Network, which comprised information from deidentified electronic health records for 90 million patients at 63 US health care organizations. The study included patients between 9 and 39 years of age.

Patients were divided into two cohorts. The first included patients who received an HPV vaccine between 2010 and 2023, and the second consisted of patients who received any other vaccine in the same period but were not administered an HPV vaccine.

The cohort of patients who received HPV vaccines included 760,540 males and 945,999 females. The other vaccination cohort comprised 760,539 males and 945,943 females. Patients in the two cohorts were matched for age, race/ethnicity and body mass index (BMI), and investigators examined cancer outcomes at least five years following vaccination.

Investigators also analyzed the correlation between vaccination history and cervical dysplasia. They identified female patients between 21 and 39 years of age who underwent pap testing, excluding patients with a prior history of abnormal findings on a pap smear. Both the HPV-vaccinated and the HPV-unvaccinated cohort included 41,676 patients. After matching for age, race/ethnicity and BMI, investigators examined the rates of dysplasia (the presence of abnormal cells, according to the National Cancer Institute), carcinoma in-situ (CIS, when abnormal cells haven't spread to nearby tissue, according to the National Cancer Institute), loop electrosurgical excision procedure (LEEP, use of a heated wire to remove abnormal tissue from a woman's lower genital tract, according to Johns Hopkins Medicine) and conization (the removal of a cone-shaped piece of abnormal tissue from the cervix, according to the National Cancer Institute).

Findings showed that a statistically significant difference was not observed between HPV-vaccinated and -unvaccinated patients regarding atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions (abnormal cells that form on the surface of some organs, according to the National Cancer Institute). However, statistically significant lower rates of high-grade squamous intraepithelial lesions, CIS, abnormal pap findings and conization/LEEP were observed for HPV-vaccinated patients versus unvaccinated patients.

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High-dose Flu Shots Reduce Hospitalizations In Older Adults, Study Finds

High-dose flu vaccines given to older adults lower pneumonia- and influenza-related (P&I) hospitalization, but there isn't a difference in death rates between people who received the high-dose and standard-dose flu shots, a new study finds.

The report was published in the Journal of Infection. 

The high-dose flu shot has four times as much hemagglutinin as standard-dose influenza shots and is recommended for adults aged 65 or more years. Older adults are at the highest risk for flu-related complications. The shot triggers a higher antibody response and has lowered the incidence of the flu in multiple studies, according to the authors of the current study.

The authors of the current study looked at existing studies on the shots during at least one flu season since 2009. Data came from 105,685 older adults. The mean age of participants across studies ranged from 66 to 85 years.

The high-dose flu shot had a P&I hospitalization rate of 0.8% compared with 1.1% in the standard flu shot. The high-dose shot showed an average vaccine efficacy of 23.5%.

When the team looked at how the shots performed with regard to all-cause hospitalization, they saw that 14.1% of high-dose flu shot recipients were hospitalized during the follow-up period, compared with 15.2% of those who had received the standard dose. The high-dose vaccine efficacy was 7.3%.

Investigators cited the DANFLU-2 trial, which is expected to conclude in 2025. That trial will look at P&I hospitalization in individuals aged 65 and older. The authors said that the results of that trial would provide further valuable evidence on the use of high-dose flu shots in older adults.The news comes as another recent report found the protective effect of annual flu vaccines does not erode when older adults receive flu shots every year. There wasn't a significantly increased risk of influenza in consecutively vaccinated participants compared with those receiving the vaccine only in the current season, the data showed.

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