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The National Vaccine Advisory Committee weighs in with eight recommendations for more stable vaccine funding.
ABSTRACT: An Institute of Medicine (IOM) committee recommended a dramatic change in the national approach to financing immunizations in the United States. Major features were an insurance mandate to cover immunization, federal government subsidy for the purchase of vaccines, and vouchers for uninsured people. The National Vaccine Advisory Committee (NVAC), while agreeing with many of the IOM observations, did not agree with the recommendations for action. NVAC recommended, among other things, expanding and stabilizing funding through the existing Vaccination Assistance Act (Section 317 of the Public Health Service Act), expansion of the Vaccines for Children program, and assurance of adequate reimbursement for administration of vaccines.
MARK PAULY has described the issues and tensions various stakeholders face regarding the financing of vaccine research, development, production, and use.1 The current mechanism of financing childhood immunizations in the United States represents a mix of private and public-sector involvement. Children may receive vaccines from private practitioners, with reimbursement from either insurers or their parents as out-of-pocket spending (43 percent of childhood vaccines).2 Most insurance plans cover childhood immunization. The Vaccines for Children (VFC) program provides an entitlement to vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) for children who are uninsured or on Medicaid, American Indians or Alaska Natives, or underinsured and receiving vaccines in federally qualified health centers (41 percent of childhood vaccines).3 Section 317 of the Public Health Service Act provides financial support to state/ local health departments to purchase and administer vaccines (11 percent of childhood vaccines).4 Finally, state and local health departments may purchase vaccines for their use (5 percent of childhood vaccines).5
* Financing child coverage. Private insurance coverage for childhood immunization is negotiated between purchasers and providers of insurance and can be modified during regular negotiations. Section 317 and state/local health department vaccine purchases are subject to legislative appropriation and hence are influenced by the overall governmental budget situation as well as by the timing of legislative sessions. For example, a new vaccine may be introduced after appropriations have already been made for a given fiscal year and there are no funds to purchase the new vaccine until the next year's appropriation. Over the years,...