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In this video, Ryan Hassan, MD, MPH, a pediatrician at Oregon Pediatrics in Happy Valley and medical director of Boost Oregon in Portland, describes some of the access issues within the U.S. healthcare system preventing parents from vaccinating their children.

The following is a transcript of his remarks:

Something that's come to the forefront of my mind recently is the problem of access, in Oregon in particular, but really in the country at large. Many people, I think, are aware of the problem of vaccine hesitancy and disinformation, but what's not as front and center, especially for a lot of clinicians, is the fact that there are a lot of people who want to get vaccines or to vaccinate their children who can't do so.

The reason for that is in many ways our for-profit health system -- the fact that we're starting from a place where if we don't charge enough money and sell enough product, then we don't get paid, right? I can't provide healthcare without taking money from someone else because otherwise, I can't live in my house, I don't have food for my family. That's a reflection of the fact that we don't have reliable social services of any kind, really.

So if you start from a for-profit system, then you have a setting where right now, for example, the COVID vaccine is commercialized and the RSV [respiratory syncytial virus] monoclonal antibody for infants is now available -- Beyfortus, also called nirsevimab. Beyfortus, the RSV monoclonal antibody, that's $500 or so per dose. That's something that clinics like mine have to buy upfront to then be able to give to patients and then charge the insurance for.

And some clinics, including mine, are not sure how much, if any, of that medication we're going to be able to order because we don't know how much we're going to be reimbursed for. We are unable to guarantee that our patients are going to get the care that they deserve because we don't know if we can stay in business if we try to do that.

It took months of planning just to make sure that hospitals this season in Oregon would be able to give the RSV antibody, because there's only one Oregon hospital enrolled in the Vaccines for Children [VFC] program. If you're not part of VFC, then you can't give this medicine to Medicaid children or VFC eligible children.

A lot of the reason people aren't enrolled in VFC is because it's very challenging to enroll. One of the requirements is that you have to have a separate private supply of the vaccine in order to participate. So if you're vaccinating with all VFC vaccines, that can cost $10, $20, $30,000 upfront to buy the vaccine and store it in the right fridge and everything and have all the logistical set up to be able to administer those. And you're not going to see that money back, sometimes for months, because you have to administer it and then charge the insurance and wait for the insurance to pay you.

That's just the tip of the iceberg in terms of why it's so hard for people to participate in this government program that is ostensibly designed to make sure everyone gets vaccines.

But in many ways now, people that I work with in the Oregon Immunization Program -- OIP, which is responsible for helping administer vaccines throughout the state -- feel that VFC is more of a barrier than an aid, in many ways.

I think it's worth noting that the reason for this requirement that VFC providers have a private stock of vaccine is because they want to prevent fraud. They don't want people to be getting a VFC vaccine if they're privately insured. And this is complicated stuff that it takes a long time to get through.

If you're privately insured, your insurance needs to pay for your vaccine, so you can't get a vaccine that the government's paid for through VFC -- that would be fraud. They're so worried about this that they put this requirement in that prevents people from being able to get vaccines at all because they can't participate in the program.

This concern about fraud is inherently racist. It stems from this outdated notion -- it's not even outdated, it's a present day, it's an ongoing idea that we've kind of ingrained in our minds -- that poor people (writ minority and marginalized communities) are lazy moochers that are just stealing from the rest of us hardworking people. Even though poor people tend to be the hardest workers in this country.

It's this idea that has ingrained itself into our institutions so that we're more worried about fraud -- people fraudulently taking vaccines or giving vaccines -- than we are about saving money and saving lives by preventing outbreaks of preventable diseases by just vaccinating everyone. I mean, it would be easier if we just made everyone eligible for VFC, but we don't want to do that because that would undermine the for-profit system in the first place.

I think that's kind of the tip of the iceberg when it comes to some of the big structural ideas and cultural traps that we've fallen into that are leading to these very real policies that have very real impacts. It stems from the fact that we just refuse to accept that we're all human, we're all doing our best, we all deserve the best, and we shouldn't have to prove ourselves worthy of healthcare, of vaccines, of a home to live in, of mental healthcare, of food by being able to contribute to the economy in some measurable way. That's essentially what it comes down to.

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