The Misery of the Vaccine Business: The Real Economics of Pediatric Vaccination In this episode of The Pediatric Lounge, the hosts reflect on the PMI conference in New Orleans and discuss how U.S. pediatricians are portrayed as “bad guys” because of vaccines, leading into a conversation with Dr. Gail Schoenfeld about the “misery of the vaccine business.” Schoenfeld describes her participation in a white paper on the real economics of pediatric vaccination, motivated in part by feeling insulted by claims that pediatricians profit from vaccines, and explains she tried to educate the authors on vaccine financing and delivery costs. The discussion details the extensive, time-intensive workflow and infrastructure required to store, track, administer, and document vaccines, including staffing time, inventory reconciliation between VFC and commercial stock, compliance tasks, refrigeration and monitoring systems, generators, maintenance, insurance, space costs, and after-hours emergencies. They address vaccine “wastage” such as broken vials, patient refusal after preparation, expiration, documentation errors that prevent billing, and demand shifts (including Schoenfeld’s experience wasting 70 Moderna COVID doses at $133 each). The group argues that fixed reimbursement set by insurers and Medicaid often fails to cover true costs, making vaccination a money-losing service for pediatric practices; they cite examples including Medicare valuing vaccine administration code 90460 at $24 and Virginia’s Medicaid not paying 90460 and restricting VFC reimbursement to a limited admin fee, resulting in losses per vaccine, with a Mississippi example of $11 payment. They discuss why adult practices often refer vaccination to pharmacies and note pediatricians cannot easily do so. The conversation expands to broader issues with Medicaid underfunding, VFC compliance burdens and liability, quality incentive programs (HEDIS/NCQA) and how incentives can be perceived as conflicts of interest despite being framed as deferred or conditional payment, and how vaccine mandates and distrust after COVID have reduced routine vaccination uptake. Schoenfeld shares past work running community COVID vaccine clinics and contrasts inefficiencies seen elsewhere. The episode ends with reflections on pediatricians being underpaid despite providing essential preventive care, Schoenfeld’s commitment to serving a largely Medicaid population in the Hamptons, and her upcoming presentation on cost center/call center reports at a future conference, followed by standard podcast outro and disclaimer. 00:00 Welcome Back + PMI New Orleans Takeaways (Why Pediatricians Support the show 🔴 Subscribe for more Doctor stories like this: 🎧Apple and give us a 5-star review. Read more on the TPL Website SOCIAL Media Pages =============================== 📝 - Substack 🎧 - PODCAST 👥 - FACEBOOK 🐦 - TWITTER 📸 - Instagram ➡️ - Linkedin The Pediatric Lounge - A Podcast taking you behind the door of the Physician's Lounge to get a deeper insight into what docs are talking about today, from the clinically profound to the wonderfully routine...and everything in between. The conversations are not intended as medical advice, and the opinions expressed are solely those of the host and guest.
