Welcome to the 35th Annual National Immunization Conference

1
IOM Workshop on Immunization Finance January
17, 2002 02wao330.ppt Walter A. Orenstein, M.D.
2
(No Transcript)
3
Immunization Finance

• Walter A. Orenstein, M.D.
• Director
• National Immunization Program
• Centers for Disease Control and Prevention

4
Comparison of 20th Century Annual Morbidity and
Current Morbidity, Vaccine-Preventable Diseases
Percent Decrease
20th Century Annual Morbidity
2001
Smallpox Diphtheria Measles Mumps Pertussis Pol
io (paralytic) Rubella Congenital Rubella
Syndrome Tetanus H. influenzae, type b and
unknown (lt5 yrs) Invasive pneumococcal
disease (lt5 yrs)
48,164 175,884 503,282 152,209 147,271 16,316 47,7
45 823 1,314 20,000
0 2 108 231 5396 0 19 2 27
100 100 100 99.80 94.70 100 99.60 98.90 97.30 99.
20 9.70
183
15,933
14,382

• Provisional DataImported cases were 47
  (43.5) Projected cases

5
Vaccine Specific Coverage Rates Among U.S. 2 Year
Olds, 1967-2001
DTP
Hep B
Measles
Polio
Hib
Varicella
Source USIS (1967-1985), NHIS (1991-1993), and
National Immunization Survey (1994-June 2000)
2001 data based on first 2 quarters of 2001
6
Selected Challenges for the Immunization Program

• New Vaccines
• Vaccine Financing
• Vaccine Supply
• Vaccine Safety
• Adult Immunization
• Detecting Problems
• Implementing Solutions

7
Six Roles of the Nations Immunization System
Assure Vaccine Purchase
AssureServiceDelivery
Control and PreventInfectiousDisease
Surveillanceof Vaccine Coverageand Safety
Sustain and ImproveCoverage Rates
Immunization FinancePolicies and Practices
8
Rec. 1 Current Budget for Purchasing Childhood
Vaccines

• Provide requested information to Congress
• Explore ways to assure adequate financing for new
  vaccines
• Contracted with IOM to review overall
  public/private sector financing

9
New IOM Vaccine Financing Study I

• Roles and responsibilities of public and private
  agencies and providers for vaccine purchase and
  administration
• Price determination for new vaccines to balance
  continued investment in vaccine research with
  constraints of health care system
• Finance strategies from these roles and
  implications

10
New IOM Vaccine Financing Study II

• Current levels of need for vaccines for persons
  without health plan coverage or with large
  deductibles or co-pay
• Reduce time lag from recommendation to
  implementation
• Future vaccine prices
• Why increase
• Lessons from other fields which finance medical
  devices or supplies

11
Study Status

• 18-month study
• Started November 2001
• Director Rosemary Chalk
• 12-member committee
• -public health -State and local health
  departments
• -health economics -health insurance plans
• -public policy -vaccine manufacture
• -public/private sector vaccine delivery
• First committee meeting March 2002

12
Rec. 2 Addl Funds for Purchasing Adolescent and
Adult Vaccines

• Explore options for providing financial support
• Urge public and private health plans provide
  adult immunization benefits
• Encourage VFC enrollment of providers who see
  older adolescents
• Promote adolescent and adult immunization
• Establish standards for immunization practices
• Develop Task Force for Community Preventive
  Services Guidelines for targeted vaccination

13
Rec. 3 Increased Spendingfor Infrastructure

• Recognize need for increased funding
• Provide technical assistance to states to
  document their contributions
• Work with immunization grantees to reduce Federal
  reporting requirements
• Explore feasibility of extending Section 317
  budget cycles

14
317 Infrastructure Funding
15
IOM 317 Grants Formula

• Purpose
• Equity
• Strategic targeting
• Transparency
• Challenges
• Relatively overfunded programs
• Opportunity
• 317 infrastructure appropriations increase

16
Development Process

• ASTHO Guiding Principles
• Agreement with concept
• 5 / yr allowable funding decrement
• Formula development
• NIP / AIM workgroup
• Used IOM report guidance
• Agreed upon criteria and weights
• Results to ASTHO and AIM for consideration

17
Criteria and Weights

• Base
• Minimum program needs
• Performance
• Childhood and adult coverage levels
• Discretion
• Outbreaks and unanticipated problems
• Need (adjusted by capacity)
• Population and rurality
• Low childhood coverage levels

18
Weights
19
Rec. 5 Prepare Legislative and Budgetary Reforms
forFY 2002 Reauthorization

• Section 317 has been reauthorized through FY 2005
• Collaborate with partners to design and implement
  budgetary and programmatic changes for FY 2002

20
Rec 6 Improved Coverage Measurement

• HEDIS childhood measure changes
• Adherent to ACIP general recs
• New vaccines added within 3 years
• NIS changes
• Models HEDIS up-to-date criteria
• Measures coverage at more ages
• New HEDIS measures
• Influenza, age 50-65
• Adult pneumococcal coverage

21
IOM Comments on State and Federal Roles

• Federal role is to supplement and support
• State legislatures and governments should be
  expected to sustain an immunization
  infrastructure
• States are the ultimate stewards of public health

Calling the Shots, National Academy Press,
2000, pp11
22
How Can CDC Help States Fulfill Their Roles in
the Immunization Infrastructure?