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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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Entertainment

Broadcaster John Stapleton has died aged 79

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Broadcaster John Stapleton has died aged 79

Broadcaster John Stapleton has died, his agent has said.

The 79-year-old, who had Parkinson’s disease complicated by pneumonia, died peacefully in hospital this morning.

Stapleton was known for his work on programmes such as Newsnight, Panorama and GMTV’s News Hour. He was among Sky News’ original presenters.

Stapleton’s agent, Jackie Gil, said: “His son Nick and daughter-in-law Lisa have been constantly at his side and John died peacefully in hospital this morning.”

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US

Luigi Mangione’s lawyers call on judge to block the death penalty

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Luigi Mangione's lawyers call on judge to block the death penalty

Lawyers for Luigi Mangione have called on a judge to block federal prosecutors from seeking the death penalty against him.

Mangione’s legal team says the 27-year-old’s case has been turned into a “Marvel movie” after a failed bid by the US Justice Department to indict him on terrorism charges over the fatal shooting of UnitedHealthcare chief executive Brian Thompson in New York on 4 December.

New York state judge Gregory Carro said there was no evidence that the killing, which took place as Mr Thompson walked into an investor conference at the New York Hilton Midtown hotel, amounted to a terrorist act.

But Judge Carro upheld second-degree murder charges, which suggest there was malicious intent – but not that it was premeditated.

US Attorney General Pam Bondi has called for Mangione to face capital punishment, describing the charges against him as a “premeditated cold-blooded assassination that shocked America”.

But in the new court filing, Mangione’s legal team argues federal prosecutors have “violated Mr Mangione’s constitutional and statutory rights” by “staging a dehumanizing, unconstitutional ‘perp walk’ where he was televised, videotaped, and photographed clambering out of a helicopter in shackles” on the way to his first court appearance.

The legal team, led by former Manhattan prosecutor Karen Friedman Agnifilo, also claims the death penalty case has been “fatally prejudiced” after President Donald Trump commented on it on Fox News.

Despite laws that prohibit any pre-trial commentary that could prejudice the defendant’s right to a free trial, he told the network on Thursday: “Think about Mangione. He shot someone in the back, as clear as you’re looking at me or I’m looking at you.”

Read more from Sky News
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UnitedHealthcare chief executive Brian Thompson.
Pic: UnitedHealth Group/AP
Image:
UnitedHealthcare chief executive Brian Thompson.
Pic: UnitedHealth Group/AP

The defence team’s 114-page court filing reads: “There is a high bar to dismissing an indictment due to pretrial publicity.

“However, there has never been a situation remotely like this one where prejudice has been so great against a death-eligible defendant.”

Federal prosecutors have until 31 October to respond to the documents.

Mangione has pleaded not guilty to all the state charges against him, which cannot result in the death penalty and only life imprisonment, unlike federal ones. He has also pleaded not guilty to the federal charges.

He is due back in court for a pre-trial hearing in the state case on 1 December and the federal case on 5 December.

The 27-year-old was arrested five days after Mr Thompson was killed – when he was spotted at a McDonald’s in Altoona, Pennsylvania, around 230 miles west of New York City.

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UK

British fighter jets defend Polish skies after Russian drone incursion

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British fighter jets defend Polish skies after Russian drone incursion

Two British fighter jets have flown their first defence mission over Poland after a Russian drone incursion into the country’s skies.

The flight was part of NATO‘s operation “Eastern Sentry”, launched to bolster Europe’s eastern flank after Poland shot down Russian drones earlier this month.

A Russian drone was intercepted flying over Romania days later, while three Russian jets entered Estonian airspace without permission for 12 minutes on Friday.

One of three Russian MiG-31 fighter jets in images shared by Sweden's armed forces. Pic: Swedish Armed Forces
Image:
One of three Russian MiG-31 fighter jets in images shared by Sweden’s armed forces. Pic: Swedish Armed Forces

The three incursions into NATO airspace fuelled concerns about the potential expansion of Russia‘s three-year war in Ukraine and have been seen as an attempt by Moscow to test the military alliance’s response.

The incident over Poland prompted its prime minister, Donald Tusk, to warn that his country was the closest to “open conflict” it had been since the Second World War, while the UK announced it would provide Warsaw with extra air cover.

Two RAF Typhoons, supported by an RAF Voyager air-to-air refuelling plane, took off from RAF Coningsby, in Lincolnshire, on Friday night to defend Poland’s skies before returning safely early on Saturday morning.

A Gerbera drone landed in a field in the Olesno region of Poland
Image:
A Gerbera drone landed in a field in the Olesno region of Poland

Defence Secretary John Healey said the mission sends a clear signal that “NATO airspace will be defended”.

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“I’m proud of the outstanding British pilots and air crew who took part in this successful operation to defend our allies from reckless Russian aggression.”

He said the mission was “especially poignant” coming as the UK marks the 85th anniversary of the Battle of Britain – when Polish pilots came to the aid of the UK – this weekend.

The head of the RAF, Air Chief Marshal Harv Smyth, said: “This sortie marks the RAF’s first operational mission on Eastern Sentry, reinforcing the UK’s steadfast commitment to NATO and its allies.

“We remain agile, integrated, and ready to project airpower at range.”

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