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Assuring the supply of vaccines

June 21, 2005

A growing national debate

The recent shortage of flu vaccine, which eventually became a surplus, points to problems with vaccine financing and production. Various solutions to these problems have been proposed, but there has been no consensus on the path to take. In an article published in the July issue of the American Journal of Preventive Medicine, a summary of the findings of the Vaccine Financing Workgroup of the National Vaccine Advisory Committee (NVAC) suggests several steps to improve the present situation. These recommendations differ from those of a recent Institute of Medicine (IOM) report.

During 2003-2004, the NVAC working group conducted a series of discussions and meetings leading to a proposal for substantial, but incremental, changes to the current system that the group feels would go a long way toward stabilizing the financing of immunizations in the United States. In contrast to the IOM recommendation to replace the current immunization financing system with an insurance mandate and system of subsidies and vouchers, the NVAC would like to see "expanded and stable funding for the existing immunization grant program, expansion of the Vaccines for Children program, regulatory harmonization, promotion of 'first dollar' insurance coverage for immunizations, and the assurance of adequate reimbursement for the administration of vaccines."

When the IOM recommended, among other things, that insurers be required to cover immunizations, that vaccine prices be set in advance of their development, and that vaccine coverage decisions include societal benefits and costs, including consideration of the impact of the price of a vaccine on recommendations for its use, there were widespread and varied responses. Editorials in the Wall Street Journal and the New York Times helped raise awareness of the complexities surrounding the vaccine industry. A briefing was held at the American Enterprise Institute at which reservations were expressed by many stakeholders about the Committee's recommendations. Questions and comments were raised by The Winter Immunization Forum of the National Partnership for Immunization and in an editorial comment in the journal Pediatrics by the past president of the American Academy of Pediatrics.

The National Vaccine Advisory Committee (NVAC) makes several recommendations to stabilize financing of immunizations in the Untied States, including: expanded and stable funding through Section 317 of the Public Health Service Act for immunization program infrastructure and operations, as well as for vaccine purchase; expanded funding through Section 317 to support adolescent and adult immunization programs; expansion of the Vaccines for Children Program to include underinsured children in all public health clinics; promotion of "first-dollar" insurance coverage for immunization; and assurance of adequate reimbursement for administration of vaccines.

The article is titled "Financing Vaccines in the 21st Century: Recommendations from the National Vaccine Advisory Committee" by Alan R. Hinman, MD, MPH, for the National Vaccine Advisory Committee and appears in the July issue of the American Journal of Preventive Medicine (Volume 29, Number 1) published by Elsevier.

Elsevier Health Sciences