Preview

New research asks the question: How successful will newly emerging vaccines be in stemming the pandemic?

Different combinations of vaccine characteristics, effectiveness, pace of distribution, and “background epidemic severity” can affect infection rates, hospitalizations, and mortality. While more effective vaccines always lead to better outcomes, the story gets more complex when you start to vary the parameters. David Paltiel and Jason Schwartz from the Yale University School of Public Health and Amy Zheng and Rochelle Walensky from Harvard Medical School walk us through the variables.

Three analytic papers review key policy questions such as why we must invest in vaccine delivery strategies; how public and private leaders can ensure equitable access; and what to consider in pricing vaccines and treatments.

Delivery strategies: Rebecca Weintraub of Adriadne Labs and colleagues analyze why leaders must invest in vaccine delivery strategies now. This paper offers recommendations for policy makers and looks at past pandemics and vaccine campaigns to offer lessons on successful vaccine delivery.
Equity: Angela Shen of Children’s Hospital of Philadelphia and colleagues offer recommendations to public and private leaders to help ensure equitable access to all who are recommended for vaccination, regardless of ability to pay, where people live, or historic or systemic limitations to health care.
Pricing: In this broad look at pricing, authors Peter Neumann of Tufts University Medical School and colleagues shed light on solutions to the "policy puzzle" of balancing lower prices to ensure access to essential medications, vaccines, and tests, while also ensuring adequate revenue streams to provide manufacturers incentives to make the substantial, risky investments needed to develop products in the first place.

In preparation for publishing these peer-reviewed papers today, Health Affairs brought researchers, industry leaders, and advocates together at an August 2020 symposium (available online) to discuss promoting vaccine and treatment innovation and equity.

Reporter Harris Meyer summarized the event in this month’s EntryPoint in Health Affairs, noting themes of collaboration and competition.

Health Affairs is grateful to the theme advisers, Helen Saxenian and Jason Schwartz, and to the following sponsors for their support of this fast-track publication and the symposium: Anthem, Inc.; Amgen Inc.; Avalere; Kaiser Permanente; Pharmaceutical Research and Manufacturers of America (PhRMA); Gilead; McKesson; Quest Diagnostics; Dynavax; Alexion; and Danaher.

COVID-19

COVID-19’s Deadly Lesson: Time To Revamp Long-Term Care
By Deborah Gastfreund Schuss (11/17/20)

COVID-19 pulled back the curtain on long-standing cracks in the entire long-term care system. Our approach to caring for the vulnerable among us has failed, with nursing home residents disproportionately stricken. It’s time to abandon our deeply entrenched and outdated views of long-term care in favor of a disruptive model that invests more heavily in home and community services. Read More >>

GOVERNMENT PROGRAMS AND POLICIES

“Better Care Plan”: A Public Option Choice
By George C. Halvorson, Stephen M. Shortell, Laurence Kotlikoff, Elizabeth Mitchell, Richard M. Scheffler, John Toussaint, Peter A. Wadsworth, and Gail R. Wilensky (11/16/20)

The public option plan outlined under the Biden-Harris health care proposal offers an opportunity to advance the use of prepaid, risk-adjusted, per-member-per-month budgets that will set the country on a path to continuously improving care and sustaining universal coverage.
Read More >>

PUBLIC HEALTH

What History Can Tell Us About Who Will Lead HHS In A Biden Administration
By Richard Sorian (11/19/20)

The person who answers this call to serve the new president, his administration, and the American people would do best to study the work, accomplishments, and criticisms of past HHS secretaries to help determine the best way forward. Read More >>

DISPARITIES

Bridging The Black Mental Health Access Gap
By Victor Agbafe, Will Boles, and Rebekah E. Gee (11/20/20)

We must address mental health gaps with an antiracist mindset. Only then can we begin to solve the mental health divide and take meaningful steps to heal our nation’s psyche.
Read More >>

FOLLOWING THE ACA

ACA Round-Up: Record-High Medical Loss Ratio Rebates, Pass-Through Funding, Preventive Services
By Katie Keith (11/17/20)

Overall, insurers owe record-high medical loss ratio rebates of nearly $2.46 billion to more than 11.2 million consumers. This represents an average of $219 in rebates per person. Consistent with prior years, the rebates are most significant in the individual market. Read More >>

Honoring Tim Jost, The Affordable Care Act Advocate
By Mark Regan (11/20/20)

Tim knows insurance regulation, and Tim knows the Affordable Care Act (ACA). That combination made it possible for him to lead the private effort to support the government’s position in the King v. Burwell premium tax credits litigation. It has also made it possible for him to support the recent private effort to defend the ACA in California v. Texas. Read More >>

MEDICAID

Administration Effectively Rescinds “Families First” Medicaid Continuous Enrollment Protection
By Sara Rosenbaum, Devon R. Minnick, Maria Velazquez, and Morgan Handley (11/18/20)

To qualify for a bump in federal Medicaid funding during the COVID-19 pandemic, states must cover COVID-19 testing and treatment, and provide continuous Medicaid enrollment throughout the pandemic. However, a new rule issued by the Trump administration significantly weakens these two protections while also imposing major new burdens on states. Read More >>

IN THE JOURNAL

BEHAVIORAL HEALTH CARE

Variation In The Effectiveness Of Collaborative Care For Depression: Does It Matter Where You Get Your Care?
By Jürgen Unützer, Andrew C. Carlo, Robert Arao, Melinda Vredevoogd, John Fortney, Diane Powers, and Joan Russo

Randomized controlled trials have demonstrated that the collaborative care model for depression in primary care is more effective than usual care, but little is known about the effectiveness of this approach in real-world settings. Jürgen Unützer and coauthors used patient-reported outcome data from 11,303 patients receiving collaborative care for depression in 135 primary care clinics to examine variations in depression outcomes.
Read More >>

COVID-19

Racial/Ethnic Differences In COVID-19 Screening, Hospitalization, And Mortality In Southeast Wisconsin
By Leonard E. Egede, Rebekah J. Walker, Emma Garacci, and John R. Raymond

Leonard Egede and coauthors examine racial and ethnic disparities in COVID-19 outcomes in Milwaukee, Wisconsin, a highly segregated “minority-majority” city. Blacks and Hispanics are 3.7 times and 3.1 times, respectively, more likely to test positive for COVID-19 than non-Hispanic Whites. Read More >>

GLOBAL HEALTH POLICY

The Macroeconomic Consequences Of Firearm-Related Fatalities In OECD Countries, 2018–30: A Value-Of-Lost-Output Analysis
By Alexander W. Peters, Rachel R. Yorlets, Mark G. Shrime, and Blake C. Alkire

Alexander Peters and coauthors estimate the macroeconomic consequences of firearm-related fatalities in the thirty-six Organization for Economic Cooperation and Development (OECD) countries. They estimate cumulative losses of $239.0 billion in economic output from 2018 to 2030, with $152.5 billion attributable to the US alone, meaning that losses in the US exceed the combined losses of all other OECD countries. Read More >>

PHARMACEUTICALS & MEDICAL TECHNOLOGY

Net Spending On Retail Specialty Drugs Grew Rapidly, Especially For Private Insurance And Medicare Part D
By Steven C. Hill, G. Edward Miller, and Yao Ding

A wide range of medications are classified as specialty drugs, including most injectables, biologics, and other drugs requiring specialized administration. According to one source, they accounted for approximately half of total US spending on retail, mail-order, and provider-administered drugs in 2018. Specialty drugs are expensive, but spending can be difficult to measure because of large manufacturer rebates. To get a clearer picture on net spending for retail specialty drugs, Steven Hill and coauthors from the Agency for Healthcare Research and Quality (AHRQ) looked at data from the Medical Expenditure Panel Survey (MEPS) and SSR Health for the period 2010–17. Read More >>

About Health Affairs

Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print and online. Late-breaking content is also found through healthaffairs.org, Health Affairs Today, and Health Affairs Sunday Update.

Project HOPE is a global health and humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981.

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