COPD patients missing out on pneumococcal vax

Changes to vaccine funding have confused GPs and risk leaving some of the most vulnerable patients unprotected.

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GPs and respiratory specialists are concerned that changes to the NIP will leave some patients with COPD at risk of potentially deadly pneumococcal infections.

People with COPD aged between 65 and 70 are no longer able to receive a free pneumococcal vaccination under changes that were pushed through in July – and Pneumovax 23 shortages around the time of the changes meant that people who would have been eligible just missed out.

The move has frustrated GPs and specialists because the vaccine protects their older patients with COPD against the potentially fatal disease, and patients are much less likely to seek or accept a vaccination if they have to pay for it.

Previously, this vaccine was subsidised by the government for people with COPD from the age of 65.

But in July this year, the Australian Technical Advisory Group on Immunisation (ATAGI) changed the Australian Immunisation Handbook such that the pneumococcal vaccine was recommended for all patients with COPD but only government-funded for those over the age of 70.

“[Under the new criteria], if you are aged between 65 and 70 and you have COPD or severe asthma, you do not get subsidised vaccination,” said Professor Christine Jenkins, the head of the respiratory group at The George Institute for Global Health, a specialist in thoracic medicine at Concord Hospital in Sydney and the chair of Lung Foundation Australia.

“You are identified as a group for whom it is recommended, but it’s not subsidised, whereas previously it would have been.”

This was a big shift for the COPD population in particular who often have a multitude of comorbidities, such as cardiac disease, osteoporosis or diabetes, that increase their risk of pneumococcal infections and its life-threatening complications, such as septicaemia, said Professor Jenkins.

“The vaccine also reduces the risk of pneumococcal pneumonia in patients with COPD – so, that’s its value,” said Professor Jenkins.
“The risk reduction is not huge, and the government has obviously decided it is not cost effective to subsidise.”
Vaccination is recommended by the COPDx guidelines, and the Lung Foundation has recommend revising the at-risk conditions list suitable for inclusion on the NIP schedule to include adults with COPD, a spokesperson told The Medical Republic.

“People with COPD have a 4.1-fold increased risk of pneumococcal pneumonia compared with the general population of the same age,” the spokesperson said.

The cost of the vaccine without a government subsidy is around $100, which makes it more difficult to encourage patients with COPD to get vaccinated before the age of 70, said Professor Jenkins.
Respiratory specialists, GPs and nurses were particularly disturbed by an error in the draft version of the Australian Immunisation Handbook that ATAGI published earlier this year, which failed to include patients with COPD and severe asthma on the list of vulnerable patients who were eligible for a free pneumococcal vaccination.

The Lung Foundation, the RACGP and the Australian Primary Health Care Nurses Association wrote to ATAGI as part of the public consultation process to ask for the error to be corrected.

ATAGI acknowledged the error and corrected the version of the handbook on the website.

“It was a serious omission,” said Professor Jenkins.

Dr Kathryn Fox, a GP at Colour City Medical Practice in Orange, NSW, said the COVID-19 pandemic had increased patient awareness of vaccines and many more people with COPD than normal were making enquiries about getting the pneumococcal vaccination.

Vaccine shortages have complicated the situation, with some patients missing out on NIP-funded pneumococcal vaccination because the Pneumovax 23 had been in short supply.

“Currently we had about 20 people on our list for vaccination and looking through that list, there’s about a third of those people who no longer qualify because they had COPD and are under 70,” she said.
For many of her patients, an expensive vaccine was not something they could afford to spend money on, she said.

Oddly enough, under the new changes older patients will now receive Prevenar 13 instead of the Pneumovax 23 – and the Prevenar 13 vaccine has not been in shortage.

It was understandably confusing to patients to be told they had been eligible under the NIP for Pneumovax 23 two months ago but couldn’t be given it due to shortages, and were now no longer eligible for Prevenar 13 but should pay around $100 for it anyway because it’s recommended, said Dr Fox.

“I guess that is just creating a very confusing message and the changes were not very well explained to GPs in advance,” said Dr Fox. “I know there are some education events for GPs and nurses to try to get us up to speed … but we had very little notice.”