Darian Woods (2:45)

So do doctors push vaccines onto patients because vaccines are profitable? For perspective on that, we first called up Jennifer Bacani McKinney.

Jennifer Bacani McKinney (2:54)

I'm a family physician in Fredonia, Kansas, which is a town of about 2,200 people in southeast Kansas.

Adrian Ma (3:02)

Jennifer has been practicing family medicine for about 16 years.

Jennifer Bacani McKinney (3:05)

We do a little bit of everything here. So we're in the clinic, hospital, we're the ER doctors, we're the nursing home, hospice doctors, all the things. So today it's relatively calm.

Adrian Ma (3:17)

Oh, wow.

Darian Woods (3:17)

Yeah.

Adrian Ma (3:17)

That's a lot for one practice.

Jennifer Bacani McKinney (3:20)

Yeah, I think it's kind of. It's what we do in rural medicine. So I like to say we're the only gig in town, and we kind of do whatever we need to do for our patients.

Darian Woods (3:29)

And that means everything from routine checkups to colonoscopies.

Adrian Ma (3:33)

And of course, that service includes vaccines.

Jennifer Bacani McKinney (3:36)

We provide flu shots and pneumonia shots. We really do a majority of adolescent and adult vaccines.

Adrian Ma (3:44)

Jennifer says the decision of whether to recommend a vaccine to a certain patient is based on long established guidelines from organizations like the Centers for Disease Control and Prevention and the American Academy of Family Physicians.

Darian Woods (3:57)

So we asked Jennifer, does providing vaccines make money for her practice?

Jennifer Bacani McKinney (4:03)

So I would say, at the best, we're breaking even with our. With our vaccines.

Adrian Ma (4:07)

The reason Jennifer says she's only breaking even is that providing vaccines come with a bunch of different costs. Typically, providers like her will purchase vaccines directly from the manufacturer. These are little vials that can cost hundreds of dollars apiece.

Darian Woods (4:22)

Then those vials have to be stored in special refrigeration units, which are not cheap. Many doctors buy insurance for those stored vaccines because if the power goes out, they don't want to lose tens of thousands of dollars. And they have to pay nurses to administer the vaccines and assistants to process the paperwork so they can actually get paid by a patient's insurance.

Adrian Ma (4:44)

But even when the payments finally come, Jennifer says it's usually not enough to make a profit.

Jennifer Bacani McKinney (4:50)

The reimbursement for the vaccine itself. Insurance companies would either barely cover the cost of the vaccine or it would be less than the cost of the vaccine.

Darian Woods (5:01)

Sometimes insurers will also pay what's called an administration fee to help cover related costs. But she says it's usually only five or ten dollars.

Jennifer Bacani McKinney (5:12)

To say that we made any money at all on vaccines is just completely false. I mean, the people who are giving vaccines in their private clinics are doing it because it's the right thing and because they can do it, but they know that it's going to be a loss or maybe break even on that cost.

Adrian Ma (5:32)

And so you can probably see how with all these costs, doctors may be forced into making some difficult decisions around vaccines. For example, Jennifer says her practice used to provide childhood vaccines for things like chickenpox and measles.

Jennifer Bacani McKinney (5:47)

The problem is each vial is expensive. And in a small town, you know, you don't. There's no guarantee that people are walking in every day needing a vaccine. So if you maybe give a few vaccines one week and then you don't give another vaccine for another month or two maybe, then those vaccines often will expire very quickly, and then you're just out that money, and that's hundreds of dollars.

Darian Woods (6:12)

So Jennifer was actually losing money by providing children's vaccines, and that's why about 10 years ago, she stopped offering them. Luckily, she says her patients could go to the town's health department for those shots.

Jennifer Bacani McKinney (6:25)

But still, I felt awful because, like I said, as a parent myself, knowing that I would rather go to one place, get my. Well, visit and get my vaccines all in one place. But I also knew if. If we were doing things that were losing money for our clinic, if we're not being financially responsible, then we're not going to be able to take care of all the patients that we need to take care of.

Adrian Ma (6:49)

Jennifer's experience is actually fairly common. According to a 2017 survey in a journal called Academic Pediatrics, 12% of pediatricians and 23% of family physicians who were surveyed said they stopped providing certain vaccines because of financial concerns. And. And yet this has not stopped RFK Jr from claiming that doctors are motivated more by money than what's good for patients.

David Higgins (7:14)

This claim is false. It is incredibly misleading, and to be honest, it's dangerous.

Darian Woods (7:22)

David Higgins is a pediatrician in Denver, Colorado. He's also a member of the American Academy of Pediatrics. David says while the vast majority of Americans trust vaccines, American RFK Jr. S attacks on them could undermine that.

David Higgins (7:36)

I think he's hitting a nerve that I understand, and that does make sense. And here's what I mean by that. Science is built on asking and answering really good questions. And that sometimes means being skeptical until it's proven that something is important and works.

Darian Woods (7:59)

And David says the evidence is in. Vaccines work. That's why organizations like the Academy of Pediatrics recommend them.

Adrian Ma (8:08)

Still, a recent poll by researchers at the University of Pennsylvania shows there's been a decline in public trust for agencies like the cdc, which had long been seen as a trusted source for vaccine information. And if this sort of vaccine skepticism continues to grow, David is concerned we could see more outbreaks of vaccine, preventable illness.

David Higgins (8:29)

Every drop that we see in vaccine uptake in a community leaves that community vulnerable to these infectious diseases.

Jennifer Bacani McKinney (8:39)

Right?

David Higgins (8:39)

These diseases are not gone. Vaccines are victims of their own success. They have worked so effectively that people don't routinely see some diseases like measles. But that doesn't mean that it's not there. As soon as vaccination rates drop in a community for, let's say, the measles disease, which is incredibly contagious. It's not a matter of if that disease is going to come back, it's a matter of when.

Darian Woods (9:08)

And when is already happening. For example, this year there's been at least 38 measles outbreaks so far, and that is more than double the number seen in all of last year.

Adrian Ma (9:19)

Each of these community level outbreaks can easily cost tens of thousands of dollars to deal with, whether in direct medical treatment or public health measures. But of course, all that pales in comparison to the actual human costs. This episode was produced by Angel Carreras and engineered by Jimmy Keeley. It was fact checked by Tyler Jones. Cake and Cannon is our editor and the indicators of production of npr.

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