# Presentation: 225168

## Vaccine Financing from the National Immunization Program’s Perspective

- Stephen L. Cochi MD, MPH
- Acting Director, National Immunization Program
- Centers for Disease Control and Prevention
- June, 2004

## Rationale for Requesting IOM Vaccine Financing Study

- Address changes in vaccine financing
- Introduction of new expensive vaccines, e.g., pneumococcal conjugate vaccine
- Limitations in federal discretionary funding
- Variations in insurance coverage      2-tiered system

## New Vaccine Paradigm

- Issue — not vaccine efficacy or safety
- Concerns — cost and implementation
- Most common childhood diseases controlled with existing vaccines
- Remaining diseases:
**Low incidence**
**High impact**
**High cost to prevent**

## Vaccine Financing Challenges

**Identifying the appropriate balance of federal, state and private insurance funding for vaccines to meet the needs of consumers and providers**
**Assuring sufficient public sector funding**
**Assuring the continued quality assurance roles of public health**

## Consumer Needs

-    Access to all recommended vaccines for all ages, regardless of insurance status
**In the medical home**
**With little or no financial barriers to vaccination**
**No/low copayment fees (1****st**** dollar coverage)**

## Provider Needs

**Ability to provide all recommended vaccines to patients of all ages, regardless of their insurance status**
**Adequate payment for vaccine purchase and administration**
**Consider replacement system for vaccine purchase??**
**Mechanisms to expedite reimbursement for newly recommended vaccines**

## Childhood Vaccine Doses Distributed by Funding SourceCalendar Year 2003

**Childhood Vaccine Doses Distributed by Funding Source****Calendar Year 2003**

- Source: Biologics Surveillance Data 2003

## Federal Contract Vaccine Prices For Vaccines Recommended Universally for Children, 1985 – 2004*

*** Federal contract price shown for one year is an average that accounts for price changes within the year.  **
**An estimate is provided for 2004 since contract prices may change in August 2004  **
**April 14, 2004**

**$45**

**$114**

**$472**

## Percent Increase of the Cost of Full Series vs. Percent Increase of Appropriation

- Percentage Calculations:  %  increases are cumulative using 1999 as the base year.

## Pneumococcal Conjugate Vaccine (PCV) Two-Tier Policies, by State, United States*

**Pneumococcal Conjugate Vaccine (PCV) ****Two-Tier Policies, by State, ****United States***

- States with a two-tiered PCV policy (19 states are not implementing PCV with 317 funds)States without a two-tiered PCV policy

- D.C.

- *As of February 2003

**If all States implemented PCV and flu, the 2004 funding shortfall would be $55 Million**

## New Vaccines to 2020

| Today
DTaP
MMR
IPV
Varicella
Hib
PCV
Hep A
Hep B
Meningococcal
Influenza |                          2020
DTaP
MMR
IPV
Varicella
Hib
PCV
Hep A
Hep B
Meningococcal
Influenza
PLUS
Chlamydia
Coccidioides immites
Cytomegalovirus
 | 
Enterotoxigenic E. coli
Epstein-Barr
Helicobacter pylori
Hepatitis C
Herpes Simplex
Histoplasma capsulatum
Human papillomavirus
Diabetes mellitus (th)
Melanoma (th)
Multiple sclerosis (th)
Mycobacterium 
      tuberculosis
Neisseria gonorrhea
Etc...... |
| --- | --- | --- |

## Concerns if Vaccine Financing Remains an Issue

**Introduction of new vaccines (or recommendations) will continue two-tier trend**
**Pressure to introduce new vaccines may force programs to provide existing vaccines through two-tiered systems**
**Variable implementation of recommendations will result in variable coverage levels and increased possibility of outbreaks**

## Six Roles of the Nation’s Immunization Program

**Assure ****Vaccine ****Purchase**

**Assure****Service****Delivery**

**Sustain ****and Improve****Coverage Rates**

**Surveillance****of Vaccine**
**Coverage****and Safety**

**Control ****and Prevent****Infectious****Disease**

**Immunization Finance****Policies and Practices**

**Six Roles of the Nation’s Immunization Program**

## Public Sector Vaccine Cost to Fully Vaccinate a Child

## Number of Children Who Could Potentially Receive Full Series with Section 317 Funds

## Key Benefits of IOM Recommendations

**Increases value of vaccines**
**Makes vaccines available as a near universal entitlement **
**Provides economic incentives for providers and manufacturers**
**Potential to reduce administrative burden on private providers**
**Allows vaccine recommendations to be made by experts without interference from standard political and budget processes**

## Key Disadvantages of IOM Recommendations

**Possibility of unintended consequences from theoretically-based, untested system**
**Reduces public health quality assurance role**
**Does not assure vaccine uptake**
**May erode public/private partnership established through public supply of vaccines**
**Federal budget will be greatly increased**