So where should we draw the line? At one point or another, ACIP may have to say the government can't afford to pay for vaccines that do not have a strong cost-benefit argument behind them. Yes, the alternative is a two-tiered system where those who can afford the vaccine can get it, and those who can't, don't. ACIP has tried to avoid that scenario in the past, but I fear it won't be able to do so much longer.