Public Health

COVID-19 vaccine costs, Paxlovid price change, new studies on long COVID symptoms and more

. 11 MIN READ

AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.

How much does COVID-19 cost? AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, breaks down how much COVID could cost you. From the risk of not getting vaccinated and the new HV.1 variant, to vaccines covered by insurance and coronavirus treatment costs in the U.S. AMA Chief Experience Officer Todd Unger hosts.

Speaker

  • Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association

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Unger: Hello and welcome to the AMA Update video and podcast. Today, we have our weekly look at the headlines with the AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia in Chicago. I'm Todd Unger, AMA's chief experience officer also in Chicago. Andrea, welcome back.

Garcia: Hi, Todd. Thanks for having me.

Unger: So hard to believe, but it is officially November. And I guess it's a bit of an understatement to say that we're not as far along as we thought we would at getting people vaccinated and protected for a potential winter surge. Andrea, what's going on with that?

Garcia: Yeah, so there was a survey of nearly 15,000 people that was presented to the CDC's Advisory Committee on Immunization Practices last week. And that survey showed that just over 7% of adults and just about 2% of children have received that updated COVID vaccine. And that was as of October 14.

So the uptake has been slow, even in populations that we know are at most risk for severe illness from COVID. Only one in five people aged 75 and older have been vaccinated along with about 15% of those aged 65 to 74.

Unger: All right, I guess numbers that low really beg for understanding. Andrea, do you think this is just a matter of people being over it, not aware of the vaccine? What gives?

Garcia: Well, that could certainly be part of it, but it's likely that people still don't understand the risk of COVID, especially certain populations. According to the CDC, we are still seeing more than 1,200 people dying of COVID each week. That number is still higher than we would like it to be. About 16,000 people were hospitalized with COVID in that week ending October 14.

And that's a much smaller number compared to the nearly 23,000 hospitalizations at the same time last year and the more than 44,000 in 2021. It's still not 0, not even close. And there's differences between populations. Hospitalizations among adults aged 75 and older are two to three times higher than for those in that 65- to 74-year-old age group. And we also continue to see those disparities in who's getting sick.

So hospitalization rates are the highest among native American, Alaska Natives and Black Americans. And those observed disparities could be the result of multiple factors. I think one of them is the fact that less than 1% of native American and Alaska Natives and 7.6% of Black Americans have received the vaccine as of October 14.

Unger: So just to reiterate statistic you mentioned there, 1,200 people dying from COVID a week. Maybe that just—we've lost our sense of perspective about just how many people that is certainly relative to the other numbers that maybe people are used to hearing. It's a lot of people. So important to get the vaccine.

Andrea, we talked a few weeks ago about some of the issues with the rollout. Does the bumpy rollout that we were experiencing have something to do with the low numbers?

Garcia: Well, that certainly hasn't helped the situation. And we've talked previously that most people should be able to get the vaccine at no cost either through private insurance, through Medicare or Medicaid. Government programs have made the vaccines available for free to children and also to adults who are underinsured or uninsured. And that's at least through the end of December 31, 2024.

Still, many people are reporting trouble getting the vaccines at pharmacies, being charged fees, or even mistakenly being turned away. And as we discussed a couple of weeks ago, at some of the pharmacies, the demand has outstripped supply, which has led to canceled appointments.

And we know doctor's offices are also frustrated. They're ordering fewer quantities. So aren't prioritized for distribution. We are hearing that that is starting to improve. So hopefully, we'll begin to see those vaccination rates go up.

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Unger: So, Andrea, I guess what we're saying is there is an access issue here. Is that the only problem that we're really seeing?

Garcia: No, absolutely not. I think that's only part of the problem. And if we look at that same CDC survey, about 38% of adults said they would not choose the vaccine for themselves and about the same percentage are saying that they would not have their children immunized. So it doesn't really matter how accessible and widely available these vaccines are if people aren't willing to get them.

I think another part of the problem may be confusion. Although the recommendations are pretty straightforward, we know that they're not necessarily being heard by the public. And as you know, this is the first year we have three respiratory virus vaccines available at the same time, which may be adding to the confusion.

People likely have questions about things like optimal timing and whether or not the vaccines can be co-administered. This is where physicians can really play a key role by talking to their patients, answering their questions, letting them know when and where to get the shots that they're eligible for and that they need.

Unger: So we have this background or backdrop of very slow vaccine uptake. And at the same time, we're seeing a new variant emerging. Is this something that we should be concerned about?

Garcia: Yeah, this didn't make many headlines, but there is a new COVID variant to keep an eye on. It's called HV.1. And according to CDC data that came out last Friday, it has already replaced EG.5 as the country's most dominant variant. HV.1 now makes up about 25% of COVID cases, which is up from about 1% at the beginning of August. EG.5 is now at 22% of cases. That's down from 24% at the start of October.

Both of these are descendants of the XBB variant. And as a reminder, the updated COVID vaccines target XBB.1.5. Experts say that these new vaccines should offer cross protection against the currently dominant strains.

Unger: So even more reason to get vaccinated. Andrea, what do we know about this new variant? Does it cause different symptoms, more severe illness?

Garcia: Well, the only thing we really know right now is this could be slightly more adept than EG.5 at spreading among people or infecting those with prior immunity to COVID. So far, it's not causing alarm. It's pretty much in line with how we expect the virus to evolve. Most scientists don't seem too concerned about versions of Omicron that look similar to those that we've seen before, which is the case here.

Unger: Good. Seems like a piece of good news. And we need that. So we have some more good news, believe it or not, this time about long COVID. Andrea, tell us more about that.

Garcia: So it's actually both good and bad news. But let's start with the good news first. There was a small study on long COVID that was published last week in the Journal of Infectious Diseases. It found no evidence of ongoing infection or brain damage among patients with persistent symptoms. This is going to be a relief to many long COVID patients, who often report those symptoms of fatigue and memory loss or impaired concentration and brain fog.

According to the study findings, there were no significant differences in the blood or cerebrospinal fluid for immune activation or brain injury biomarkers compared with those in the control group. So this suggests that long COVID is more likely a consequence of events that occurred during that acute phase of the illness rather than an ongoing viral infection or persistent inflammation of the central nervous system.

Unger: You mentioned some bad news possibly. What are we hearing there?

Garcia: Well, there was a second study that was published in BMC Infectious Diseases. And researchers in Norway examined registry data to assess the prevalence and risk factors for long COVID at least three months after an infection. So they looked at more than 50,000 people who tested positive for COVID between February of 2020 and 2021. They were compared with more than 485,000 uninfected matched control participants.

They found that COVID survivors had higher rates of most studied symptoms compared to the controls. And the greatest risk was shortness of breath, fatigue, memory loss and headache. Researchers specifically found the risk of fatigue or shortness of breath more than doubled 3 to 12 months after COVID compared to the control group.

Researchers also noted that the likelihood for memory disturbance; other respiratory symptoms; pain in the abdomen, chest or musculoskeletal system; and headache were significantly higher in that COVID group. So we may not see that lasting brain damage. But some people can certainly expect to experience certain symptoms months or even up to a year after infection.

Unger: All right. And this long COVID is an area of great interest. We're going to continue to keep a close eye on that and update you further. We talked a lot about the new COVID shots and the challenges with distribution over the past few weeks. Some of this is because the commercialization of those vaccines. The same thing is now happening with COVID treatments. Andrea, what does that mean?

Garcia: Yeah, so starting today, November 1, certain COVID treatments are no longer going to be purchased and distributed by the government. And they will end up being pretty expensive. Pfizer is pricing their five-day course of Paxlovid at around $1,400. That doesn't mean that's what people are going to pay out of pocket. Many Americans will still be able to access those pills at no cost.

For now, that's because millions of taxpayer funded courses of the pills are going to remain in pharmacies, hospitals and doctors' offices across the country. When those supplies do run out, that's when people with private insurance will start to notice co-pays for those treatments. Under a new agreement between Pfizer and the federal government, people on Medicaid, Medicare and those without medical insurance will not pay any out-of-pocket costs for the treatment. And that's through the end of next year.

Pfizer is also going to offer co-pay assistance for the treatment through 2028. The VA, the DOD and the Indian Health Service will also be able to access Paxlovid that the government has on hand.

Unger: Andrea, is Paxlovid the only treatment that's affected by this commercialization issue?

Garcia: No, it's not. The less commonly used COVID-19 treatment Lagevrio, which is manufactured by Merck, also hits the commercial market. At the time of this filming, Merck hasn't confirmed the list price for that. They did say, however, that they will make that treatment free to patients who without assistance could not otherwise afford the product.

Unger: All right, well, thank you for that update. Andrea, as always, great to have you here for our weekly check-in. That wraps up today's episode. If you enjoyed this discussion, you can support more programming like it by becoming an AMA member at ama-assn.org/join. We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.


Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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