By Jackie Fortiér for KFF Health News.
Broadcast version by Suzanne Potter for California News Service reporting for the KFF Health News-Public News Service Collaboration

When pediatrician Eric Ball opened a refrigerator full of childhood vaccines, all the expected shots were there — DTaP, polio, pneumococcal vaccine — except one.

“This is where we usually store our covid vaccines, but we don’t have any right now because they all expired at the end of last year and we had to dispose of them,” said Ball, who is part of a pediatric practice in Orange County, California.

“We thought demand would be way higher than it was.”

Pediatricians across the country are pre-ordering the updated and reformulated covid-19 vaccine for the fall and winter respiratory virus season, but some doctors said they’re struggling to predict whether parents will be interested. Providers like Ball don’t want to waste money ordering doses that won’t be used, but they need enough on hand to vaccinate vulnerable children.

The Centers for Disease Control and Prevention recommends that anyone 6 months or older get the updated covid vaccination, but in the 2023-24 vaccination season only about 15% of eligible children in the U.S. got a shot.

Ball said it was difficult to let vaccines go to waste last year. It was the first time the federal government was no longer picking up the tab for the shots, and providers had to pay upfront for the vaccines. Parents would often skip the covid shot, which can have a very short shelf life compared with other vaccines.

“Watching it sitting on our shelves expiring every 30 days, that’s like throwing away $150 repeatedly every day, multiple times a month,” Ball said.

This year, Ball slashed his fall vaccine order to the bare minimum to avoid another costly mistake.

“We took the number of flu vaccines that we order, and then we ordered 5% of that in covid vaccines,” Ball said. “It’s a guess.”

That small vaccine order cost more than $63,000, he said.

Pharmacists, pharmacy interns, and techs are allowed to give covid vaccines only to children age 3 and up, meaning babies and toddlers would need to visit a doctor’s office for inoculation.

It’s difficult to predict how parents will feel about the shots this fall, said Chicago pediatrician Scott Goldstein. Unlike other vaccinations, covid shots aren’t required for kids to attend school, and parental interest seems to wane with each new formulation, he said. For a physician-owned practice such as Goldstein’s, the upfront cost of the vaccine can be a gamble.

“The cost of vaccines, that’s far and away our biggest expense. But it’s also the most important thing we do, you could argue, is vaccinating kids,” Goldstein said.

Insurance doesn’t necessarily cover vaccine storage accidents, which can put the practice at risk of financial ruin.

“We’ve had things happen like a refrigerator gets unplugged. And then we’re all of a sudden out $80,000 overnight,” Goldstein said.

South Carolina pediatrician Deborah Greenhouse said she would order more covid vaccines for older children if the pharmaceutical companies that she buys from had a more forgiving return policy.

“Pfizer is creating that situation. If you’re only going to let us return 30%, we’re not going to buy much,” she said. “We can’t.”

Greenhouse owns her practice, so the remaining 70% of leftover shots would come out of her pocket.

Vaccine maker Pfizer will take back all unused covid shots for young children, but only 30% of doses for people 12 and older.

Pfizer said in an Aug. 20 emailed statement, “The return policy was instituted as we recognize both the importance and the complexity of pediatric vaccination and wanted to ensure that pediatric offices did not have hurdles to providing vaccine to their young patients.”

Pfizer’s return policy is similar to policies from other drugmakers for pediatric flu vaccines, also recommended during the fall season. Physicians who are worried about unwanted covid vaccines expiring on the shelves said flu shots cost them about $20 per dose, while covid shots cost around $150 per dose.

“We run on a very thin margin. If we get stuck holding a ton of vaccine that we cannot return, we can’t absorb that kind of cost,” Greenhouse said.

Vaccine maker Moderna will accept covid vaccine returns, but the amount depends on the individual contract with a provider. Novavax will accept the return of only unopened vaccines and doesn’t specify the amount they’ll accept.

Greenhouse wants to vaccinate as many children as possible but said she can’t afford to stock shots with a short shelf life. Once she runs out of the doses she’s ordered, Greenhouse said, she plans to tell families to go to a pharmacy to get older children vaccinated. If pediatricians around the country are making the same calculations, doses for very small children could be harder to find at doctors’ offices.

“Frankly, it’s not an ideal situation, but it’s what we have to do to stay in business,” she said.

Ball, the California pediatrician, worries that parents’ limited interest has caused pediatricians to minimize their vaccine orders, in turn making the newest covid shots difficult to find once they become available.

“I think there’s just a misperception that it’s less of a big deal to get covid, but I’m still sending babies to the hospital with covid,” Ball said. “We’re still seeing kids with long covid. This is with us forever.”


Jackie Fortiér wrote this story for KFF Health News.


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Two specific types of cancer are showing up in high numbers among people in jail and prison and Illinois is no exception.

A new study found a lack of resources for on-site treatment is one reason for the high rates. The data showed diagnoses and mortality numbers for liver and lung cancer are more prevalent among county jails and state prisons.

Dr. Jingxuan Zhao, senior scientist for the American Cancer Society and lead author of the study, said individuals may need to be transferred to outside facilities to receive cancer treatment, which is often denied or delayed, and people with cancer and those behind bars share some characteristics or risk factors.

"For example, some of the risk factors for developing liver cancer included hepatitis B and C," Zhao pointed out. "As we know that for lung cancer, smoking is a huge risk factor and those factors are also very common among people who are currently incarcerated or with incarceration history."

She added studies have shown people who have been incarcerated are actually more likely to receive breast and colorectal cancer screenings, compared to their counterparts. The Prison Policy Initiative estimates about 28,000 people are in Illinois state prisons, with another 17,000 in local jails.

The study examined the association of county jail and state prison incarceration rates and cancer mortality rates in the U.S., using data taken from nearly 3,100 counties and every state. Zhao noted researching incarceration and cancer care comes with some built-in challenges.

"There are several reasons, such as privacy and ethical concerns, also legal protection of incarceration data, and more importantly, the decentralization of the U.S. correctional system," Zhao outlined. "There are some ongoing efforts to link state cancer registry data and the state correctional facility data, but that's only among some single states."

Zhao added there is no multistate linkage for data, which is an important part for their research. The study stated the U.S. has one of the highest incarceration rates in the world. In one recent year, there were 350 people in prison and another 192 in jail per 100,000 population.


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Medical professionals and advocates in the Latino community are using National Hispanic Heritage Month to encourage residents to prepare for the upcoming cold and flu season.

The nonprofit Latinx Voces has teamed up with the drug company Pfizer to dispel myths about vaccines.

Paulina Sosa, founder of the group, said a recent webinar focused on the importance of immunizations and now they are taking the message out into the community.

"Explain what is a vaccine, what makes it safe, and how do you know if you can trust it," Sosa outlined. "Hopefully walking people through this will really help educate and inform them, but also helps remove that hesitancy or the fear they have around this vaccine."

According to the latest information from the U.S. Department of Health and Human Services, Hispanic adults were 30% less likely to have received a flu vaccine than non-Hispanic whites. A link to the webinar is available at LatinxTaskForce.org.

Sosa pointed out a lot of fear about vaccinations within the Latino community is fueled by misinformation.

"A lot of people still believe that they're going to get the chip, or it's gonna affect fertility," Sosa explained. We still are finding that there is a lot of misinformation that's really creating this consistent fear and hesitancy around all kinds of vaccines."

She said as we enter the respiratory season, they want to ensure residents have correct information about COVID, flu, pneumonia and RSV vaccines.

"We want to give you the information but we also want to remove the barriers to access," Sosa emphasized. "How can we do that? Partnering with health fairs, partnering with clinics, making sure that information is in Spanish and that you feel safe to ask your questions."


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October is Health Literacy Month and a medical professional is educating Pennsylvanians about heart inflammation, a condition which can lead to serious cardiac events if left untreated.

In 2021, the age-adjusted death rate of heart disease was 180 per 100,000 Pennsylvania residents.

Dr. Philip Nimoityn, clinical assistant professor of medicine at Sidney Kimmel Medical College and Cardiology Consultants of Philadelphia, said recent medical research has uncovered new preventive measures and treatments for heart attacks, the leading cause of death in the U.S. He added within the past year, a new drug has become available to directly target inflammation in the heart and can significantly decrease risk.

"This drug, which is low-dose Colchicine, which is marketed under the name of Lodoco, has been shown in individuals with either coronary artery disease or multiple risk factors for coronary artery disease to be able to decrease heart attack, stroke, cardiovascular death," Nimoityn outlined.

According to the Centers for Disease Control and Prevention, three primary risk factors for heart disease are hypertension, elevated cholesterol and smoking, with nearly half of Americans having at least one of the conditions.

Nimoityn emphasized the importance of maintaining heart health, including avoiding gut problems through a healthy diet. He added gut microbiome, a population of microorganisms, live in your gut.

"It's estimated there are 10 trillion organisms in your gut, and they produce 10% of your body's chemicals, which are called metabolites," Nimoityn explained. "The type of bacteria that grow are influenced by what you eat. So, for instance, if you were to eat beef, that would increase the growth of bacteria which release inflammatory metabolites."

He added the new treatment has seen a substantial 31% increase in the demand for coronary revascularization procedures such as stenting and bypass surgery. He recommended Pennsylvania start screening for heart disease early in life, especially if you have a family history.


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