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The world is entering a new era of vaccines. Following the success of covid-19 mRNA shots, scientists have a far greater capacity to tailor shots to a viruss structure, putting a host of new vaccines on the horizon.

This story also ran on Time. It can be republished for free.

The most recent arrivals as anyone on the airwaves or social media knows are several new immunizations against respiratory syncytial virus, or RSV.

These shots are welcome since RSV can be dangerous, even deadly, in the very old and very young. But the shots are also expensive about $300 for those directed at adults, and up to $1,000 for one of the shots, a monoclonal antibody rather than a traditional vaccine, intended for babies. Many older vaccines cost pennies.

So their advent is forcing the United States to face anew questions it has long sidestepped: How much should an immunization that will possibly be given maybe yearly to millions of Americans cost to be truly valuable? Also, given the U.S. is one of two countries that permit direct advertising to consumers: How can we ensure the shots get into the arms of people who will truly benefit and not be given, at great expense, to those who will not?

Already, ads on televisions and social media show active retirees playing pickleball or going to art galleries whose lives are cut short by RSV. This explains the lines for the shot at my local pharmacy.

But indiscriminate use of expensive shots could strain both public and private insurers already tight budgets. Email Sign-Up

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Other developed countries have deliberate strategies for deciding which vulnerable groups need a particular vaccine and how much to pay for it. The U.S. does not, and as specialized vaccines proliferate, public programs and private insurers will need to grapple with how to use and finance shots that can be hugely beneficial for some but will waste precious health dollars if taken by all.

A seasonal viral illness, RSV can cause hospitalization or, in rare cases, death in babies and in people age 75 or older, as well as those with serious underlying medical conditions such as heart disease or cancer. For most people who get RSV, it plays out as a cold; youve likely had RSV without knowing it.

But RSV puts about 2% of babies under age 1 in the hospital and kills between 100 and 300 of those under 6 months, because their immune systems are immature and their airways too narrow to tolerate the inflammation. Merely having a bad case of RSV in young childhood increases the risk of long-term asthma.

Thats why Barney Graham, the scientist who spent decades at the governments National Institutes for Health perfecting the basic science that led to the current shots, said: The most obvious use is in infants, not adults.

Thats also why European countries trying to figure out how best to use these vaccines without breaking the bank focused first on babies and determining a sensible price. Though more of the very old may die of RSV, the years of life lost are much greater for the very young. (Babies can get the monoclonal antibody shot or gain protection through a traditional vaccine given to the mother near the end of pregnancy, conferring immunity through the womb.)

A consortium of European experts led by Philippe Beutels, a professor in health economics at the University of Antwerp in Belgium, calculated that the shots would only be worth it in terms of the lives saved and hospitalizations averted in infants if the price were under about $80, he said in a phone interview. Thats because almost all babies make it through RSV with supportive care.

The calculation will be used by countries such as Belgium, England, Denmark, Finland, and the Netherlands to negotiate a set price for the two infant shots, followed by decisions on which version should be offered, depending partly on which is more affordable.

They have not yet considered how to distribute the vaccines to adults considered less pressing because studies show that RSV rarely causes severe disease in adults who live outside of care settings, such as a nursing home.

Why did the United States and Europe approach the problem from opposite directions?

In the U.S., there was a financial incentive: Roughly 3.7 million babies are born each year, while there are about 75 million Americans age 60 and older the group for whom the two adult vaccines were approved. And about half of children get their vaccines through the Vaccines for Children program, which negotiates discounted prices.

Also, babies can get vaccinated only by their clinicians. Adults can walk into pharmacies for vaccinations, and pharmacies are only too happy to have the business.

But which older adults truly benefit from the shot? The two manufacturers of the adult vaccines, GSK and Pfizer, conducted their studies presented to the FDA for approval in a population of generally healthy people 60 and older, so thats the group to whom they may be marketed. And marketed they are, even though the studies didnt show the shots staved off hospitalization or death in people ages 60 to 75.

That led to what some have called a narrow endorsement from the Centers for Disease Control and Preventions Advisory Committee on Immunization Practices for people 60 to 75: Patients in that age range could get the shot after shared clinical decision-making with a health provider.

It is likely that because of this fuzzy recommendation, some Americans 60 and over with commercial insurance are finding that their insurers wont cover it. Under Obamacare, insurers are generally required to cover at no cost vaccines that are recommended by the ACIP; however, if a provider recommends vaccination, then it must be covered by insurance.

(In late September, the ACIP recommended immunization of all babies with either the antibody or the maternal vaccine. Insurers have a year to commence coverage and many have been dragging their feet because of the high price.)

There are better and more equitable ways to steer the shots into the arms of those who need it, rather than simply administering it to those who have the right insurance or, swayed by advertising, can pay. For example, insurers, including Medicare, could be required to cover only those ages 60 to 75 who have a prescription from a doctor, indicating shared decision-making has occurred.

Finally, during the pandemic emergency, the federal government purchased all covid-19 vaccines in bulk at a negotiated price, initially below $20 a shot, and distributed them nationally. If, to protect public health, we want vaccines to get into the arms of all who benefit, thats a more cohesive strategy than the patchwork one used now.

Vaccines are miraculous, and its great news that they now exist to prevent serious illness and death from RSV. But using such novel vaccines wisely directing them to the people who need them at a price they can afford will be key. Otherwise, the cost to the health system, and to patients, could undermine this big medical win.

Elisabeth Rosenthal: erosenthal@kff.org, @RosenthalHealth Related Topics Aging Health Care Costs Health Industry Pharmaceuticals Public Health CDC Children's Health Drug Costs Vaccines Contact Us Submit a Story Tip

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It’s MLB Home Run Derby Day! Predictions, live updates and takeaways

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It's MLB Home Run Derby Day! Predictions, live updates and takeaways

It’s 2025 MLB All-Star Home Run Derby day in Atlanta!

Some of the most dynamic home run hitters in baseball will be taking aim at the Truist Park stands on Monday (8 p.m. ET on ESPN) in one of the most anticipated events of the summer.

While the prospect of a back-to-back champion is out of the picture — 2024 winner Teoscar Hernandez is not a part of this year’s field — a number of exciting stars will be taking the field, including Atlanta’s own Matt Olson, who replaced Ronald Acuna Jr. just three days before the event. Will Olson make a run in front of his home crowd? Will Cal Raleigh show off the power that led to 38 home runs in the first half? Or will one of the younger participants take the title?

We have your one-stop shop for everything Derby related, from predictions to live updates once we get underway to analysis and takeaways at the night’s end.


MLB Home Run Derby field

Cal Raleigh, Seattle Mariners (38 home runs in 2025)
James Wood, Washington Nationals (24)
Junior Caminero, Tampa Bay Rays (23)
Byron Buxton, Minnesota Twins (21)
Brent Rooker, Athletics (20)
Matt Olson, Atlanta Braves (17)
Jazz Chisholm Jr., New York Yankees (17)
Oneil Cruz, Pittsburgh Pirates (16)


Live updates


Who is going to win the Derby and who will be the runner-up?

Jeff Passan: Raleigh. His swing is perfect for the Derby: He leads MLB this season in both pull percentage and fly ball percentage, so it’s not as if he needs to recalibrate it to succeed. He has also become a prolific hitter from the right side this season — 16 home runs in 102 at-bats — and his ability to switch between right- and left-handed pitching offers a potential advantage. No switch-hitter (or catcher for that matter) has won a Home Run Derby. The Big Dumper is primed to be the first, beating Buxton in the finals.

Alden Gonzalez: Cruz. He might be wildly inconsistent at this point in his career, but he is perfect for the Derby — young enough to possess the stamina required for a taxing event that could become exhausting in the Atlanta heat; left-handed, in a ballpark where the ball carries out better to right field; and, most importantly, capable of hitting balls at incomprehensible velocities. Raleigh will put on a good show from both sides of the plate but will come in second.

Buster Olney: Olson. He is effectively pinch-hitting for Acuna, and because he received word in the past 72 hours of his participation, he hasn’t had the practice rounds that the other competitors have been going through. But he’s the only person in this group who has done the Derby before, which means he has experienced the accelerated pace, adrenaline and push of the crowd.

His pitcher, Eddie Perez, knows something about performing in a full stadium in Atlanta. And, as Olson acknowledged in a conversation Sunday, the park generally favors left-handed hitters because of the larger distances that right-handed hitters must cover in left field.

Jesse Rogers: Olson. Home-field advantage will mean something this year as hitting in 90-plus degree heat and humidity will be an extra challenge in Atlanta. Olson understands that and can pace himself accordingly. Plus, he was a late addition. He has got nothing to lose. He’ll outlast the young bucks in the field. And I’m not putting Raleigh any lower than second — his first half screams that he’ll be in the finals against Olson.

Jorge Castillo: Wood. His mammoth power isn’t disputed — he can jack baseballs to all fields. But the slight defect in his power package is that he doesn’t hit the ball in the air nearly as often as a typical slugger. Wood ranks 126th out of 155 qualified hitters across the majors in fly ball percentage. And he still has swatted 24 home runs this season. So, in an event where he’s going to do everything he can to lift baseballs, hitting fly balls won’t be an issue, and Wood is going to show off that gigantic power en route to a victory over Cruz in the finals.


Who will hit the longest home run of the night — and how far?

Passan: Cruz hits the ball harder than anyone in baseball history. He’s the choice here, at 493 feet.

Gonzalez: If you exclude the Coors Field version, there have been just six Statcast-era Derby home runs that have traveled 497-plus feet. They were compiled by two men: Aaron Judge and Giancarlo Stanton. James Wood — all 6-foot-7, 234 pounds of him — will become the third.

Olney: James Wood has the easy Stanton- and Judge-type power, and he will clear the Chophouse with the longest homer. Let’s say 497 feet.

Rogers: Hopefully he doesn’t injure himself doing it, but Buxton will break out his massive strength and crush a ball at least 505 feet. I don’t see him advancing far in the event, but for one swing, he’ll own the night.

Castillo: Cruz hits baseballs hard and far. He’ll crush a few bombs, and one will reach an even 500 feet.


Who is the one slugger fans will know much better after the Derby?

Passan: Buxton capped his first half with a cycle on Saturday, and he’ll carry that into the Derby, where he will remind the world why he was baseball’s No. 1 prospect in 2015. Buxton’s talent has never been in question, just his health. And with his body feeling right, he has the opportunity to put on a show fans won’t soon forget.

Olney: Caminero isn’t a big name and wasn’t a high-end prospect like Wood was earlier in his career. Just 3½ years ago, Caminero was dealt to the Rays by the Cleveland Guardians in a relatively minor November trade for pitcher Tobias Myers. But since then, he has refined his ability to cover inside pitches and is blossoming this year into a player with ridiculous power. He won’t win the Derby, but he’ll open some eyes.


What’s the one moment we’ll all be talking about long after this Derby ends?

Gonzalez: The incredible distances and velocities that will be reached, particularly by Wood, Cruz, Caminero, Raleigh and Buxton. The hot, humid weather at Truist Park will only aid the mind-blowing power that will be on display Monday night.

Rogers: The exhaustion on the hitter’s faces, swinging for home run after home run in the heat and humidity of Hot-lanta!

Castillo: Cruz’s 500-foot blast and a bunch of other lasers he hits in the first two rounds before running out of gas in the finals.

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Report: Sternberg to sell Rays for $1.7 billion

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Report: Sternberg to sell Rays for .7 billion

Tampa Bay Rays owner Stu Sternberg has agreed in principle to a $1.7 billion deal to sell the franchise to a group led by a Florida-based developer Patrick Zalupski, according to a report from The Athletic.

The deal is reportedly expected to be closed as early as September and will keep the franchise in the area, with Zalupski, a homebuilder in Jacksonville, having a strong preference to land in Tampa rather than St. Petersburg.

Sternberg bought the Rays in 2004 for $200 million.

According to Zalupski’s online bio, he is the founder, president and CEO of Dream Finders Homes. The company was founded in December 2008 and closed on 27 homes in Jacksonville the following year. Now, with an expanded footprint to many parts of the United States, Dream Finders has closed on more than 31,100 homes since its founding.

He also is a member of the board of trustees at the University of Florida.

The new ownership group also reportedly includes Bill Cosgrove, the CEO of Union Home Mortgage, and Ken Babby, owner of the Akron RubberDucks and Jacksonville Jumbo Shrimp, both minor-league teams.

A year ago, Sternberg had a deal in place to build a new stadium in the Historic Gas Plant District, a reimagined recreational, retail and residential district in St. Petersburg to replace Tropicana Field.

However, after Hurricane Milton shredded the roof of the stadium last October, forcing the Rays into temporary quarters, Sternberg changed his tune, saying the team would have to bear excess costs that were not in the budget.

“After careful deliberation, we have concluded we cannot move forward with the new ballpark and development project at this moment,” Sternberg said in a statement in March. “A series of events beginning in October that no one could have anticipated led to this difficult decision.”

MLB commissioner Rob Manfred and some other owners began in March to privately push Sternberg to sell the franchise, The Athletic reported.

It is unclear what Zalupski’s group, if it ultimately goes through with the purchase and is approved by MLB owners, will do for a permanent stadium.

The Rays are playing at George M. Steinbrenner Field in Tampa, located at the site of the New York Yankees‘ spring training facility and home of their Single-A Tampa Tarpons.

Field Level Media contributed to this report.

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Ohtani hits leadoff for NL; Raleigh cleanup for AL

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Ohtani hits leadoff for NL; Raleigh cleanup for AL

ATLANTA — Shohei Ohtani will bat leadoff as the designated hitter for the National League in Tuesday night’s All-Star Game at Truist Park, and the Los Angeles Dodgers star will be followed in the batting order by left fielder Ronald Acuna Jr. of the host Atlanta Braves.

Arizona second baseman Ketel Marte will hit third in the batting order announced Monday by Dodgers manager Dave Roberts, followed by Los Angeles first baseman Freddie Freeman, San Diego Padres third baseman Manny Machado, Dodgers catcher Will Smith, Chicago Cubs right fielder Kyle Tucker, New York Mets shortstop Francisco Lindor and Cubs center fielder Pete Crow-Armstrong.

Pittsburgh Pirates right-hander Paul Skenes will start his second straight All-Star Game, Major League Baseball announced last week. Detroit Tigers left-hander Tarik Skubal will make his first All-Star start for the American League.

“I think when you’re talking about the game, where it’s at, these two guys … are guys that you can root for, are super talented, are going to be faces of this game for years to come,” Roberts said.

Detroit second baseman Gleyber Torres will lead off for the AL, followed by Tigers left fielder Riley Greene, New York Yankees right fielder Aaron Judge, Seattle Mariners catcher Cal Raleigh, Toronto Blue Jays first baseman Vladimir Guerrero Jr., Baltimore Orioles designated hitter Ryan O’Hearn, Tampa Bay Rays third baseman Junior Caminero, Tigers center fielder Javy Báez and Athletics shortstop Jacob Wilson.

Ohtani led off for the AL in the 2021 All-Star Game, when the two-way sensation also was the AL’s starting pitcher. He hit leadoff in 2022, then was the No. 2 hitter for the AL in 2023 and for the NL last year after leaving the Los Angeles Angels for the Dodgers.

Skenes and Skubal are Nos. 1-2 in average four-seam fastball velocity among those with 1,500 or more pitches this season, Skenes at 98.2 mph and Skubal at 97.6 mph, according to MLB Statcast.

A 23-year-old right-hander, Skenes is 4-8 despite a major league-best 2.01 ERA for the Pirates, who are last in the NL Central. The 2024 NL Rookie of the Year has 131 strikeouts and 30 walks in 131 innings.

Skubal, a 28-year-old left-hander, is the reigning AL Cy Young Award winner. He is 10-3 with a 2.23 ERA, striking out 153 and walking 16 in 121 innings.

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