Immunization Program Resources: Planning and Forecasting Immunization Program Managers Meeting Atlanta, Georgia July 11, 2014

Transcription

1 Immunization Program Resources: Planning and Forecasting Immunization Program Managers Meeting Atlanta, Georgia July 11, 2014 Kristin Pope, Associate Director for Policy National Center for Immunization and Respiratory Diseases

2 Immuniza(on in the United States Most vaccine- preventable diseases at record lows Achieved & sustained high childhood immuniza:on Reduced dispari:es in childhood coverage Introduced mul:ple new vaccines Improved produc:on and suppliers of influenza vaccine Combina:on of public and private insurance make vaccines accessible to virtually all children and adolescents

3 Increase in Pediatric and Adolescent Vaccines, Doses, and Cost of Products: 1990, 2000, and 2014 $2,000 $1,723 $1,800 $1,600 $1,400 $1,200 $1,000 $800 $600 $400 $370 3 HPV 2 rotavirus 2 hep A 2 MCV 1 Tdap 20 flu 4 PCV13 2 varicella 3 hep B 3 Hib 2 MMR $200 $0 $ represents minimum cost to vaccinate a child (birth through 18); exceptions are 1) no preservative pediatric influenza vaccine, and 2) HPV for males and females. Federal contract prices as of February 1, 1990, September 27, 2000, and May 1, polio 5 DTaP

4 VFC Resources Represent Majority of CDC Immuniza(on Budget VFC and Discre(onary Immuniza(on Funding: FY FY 2015 President s Budget $5,000,000,000 $4,500,000,000 $4,000,000,000 $3,500,000,000 $3,000,000,000 $2,500,000,000 $2,000,000,000 $1,500,000,000 $1,000,000,000 $500,000,000 $0 VFC PPHF ARRA Immunization * Program Operations Section 317 * FY 2014 Omnibus establishes an Immunization line and eliminates the Section 317 and Program Implementation and Accountability sublines; activities in the former sublines are expected to continue.

5 CDC Discre(onary Immuniza(on Funding has Grown more Diverse and Complex Discre(onary Immuniza(on Funding: FY FY 2015 PB* $1,000,000,000 $900,000,000 $800,000,000 $700,000,000 $600,000,000 $500,000,000 $400,000,000 $300,000,000 $200,000,000 $100,000,000 $0 PPHF ARRA Immunization* Pgm Imp & Acct Section 317 * FY 2014 Omnibus establishes an Immunization line and eliminates the Section 317 and Program Implementation and Accountability sublines; activities in the former sublines are expected to continue.

6 Strategic Investments in Immuniza(on: Preven(on and Public Health Fund FY2011 FY 2014 $200,000, $180,000, $160,000, $140,000, $120,000, $100,000, $80,000, $60,000, $40,000, $20,000, $0.00 FY 2011 FY 2012 FY 2013 FY 2014 Evidence Base Communications Modernization Vaccine & State Ops

7 FY 2015 President s Budget: Immuniza(on Immunization Program** FY 2013* Final FY 2014 Enacted FY 2015 President s Budget FY /- FY 2014 $552.0M $612.0M $560.5M -$51.5M - Budget Authority $448.2M $438.8M $420.3M -$18.5M PHS Evaluation $12.9M $12.9M $12.9M $0.0 - PPHF $90.9M $160.3M $127.3M -$33.0M *FY 2013 levels have been made comparable to FY 2014 Enacted to reflect the permanent realignment of the BSS budget line. ** The Immunization Program line is consolidation of the Section 317 Program line and Program Implementation and Accountability line. It includes approximately $18M that goes to support vaccine safety activities. See: CDC s Immunization and Respiratory Narrative as submitted with FY15 President s Budget

8 Immuniza(on Request FY 2015 President s Budget Health insurance expansion will further increase access to immuniza(ons and is expected to decrease the number of uninsured and underinsured individuals in need of Sec(on 317 vaccine for rou(ne immuniza(ons. Target decrease to vaccine purchase Dedicate $8M for billing in public health departments Allocate vaccine direct assistance based on uninsured popula(ons See: CDC s Immunization and Respiratory Narrative as submitted with FY15 President s Budget

9 Immuniza(on Priori(es FY 2015 President s Budget Preserve core public health immuniza(on infrastructure at local, state, and federal levels Make strategic investments to modernize immuniza(on infrastructure, address key gaps in evidence base and improve efficiency Maintain adequate vaccine purchase as safety net for uninsured adults, VPD outbreaks and other urgent needs See: CDC s Immunization and Respiratory Narrative as submitted with FY15 President s Budget

10 Sec(on 317 Report to Congress First report requested in FY 2007 House and Senate Appropria:ons CommiJee Report Language Request for CDC s professional judgment for a comprehensive immuniza:on program vaccine purchase and opera:ons Professional judgment takes into account changing health care landscape Professional judgment for a steady state program not implementable in one fiscal year Prepared independent of the President s Budget request and Administra:on and agency priori:es

11 FY 2013 Sec(on 317 Report to Congress Summary of Professional Judgment* Program opera:ons es:mate: $742.7M State and local: $599.8 million Na:onal: $142.9 million Vaccine purchase es:mate: $220.7M Uninsured adults: $207.5 million Time- sensi:ve public health needs: $13.4 million * From the Report to Congress on the Section 317 Immunization Program submitted by CDC in response to FY 2013 Senate Report , page 59

12 FY 2013 Sec(on 317 Report to Congress Methodology Local and State opera:ons Opera:ons cost per dose of federal vaccine purchased from CDC contracts FY 2000 benchmark Na:onal opera:ons Opera:ons cost per dose of all domes:cally purchased vaccine (public and private) FY 2000 benchmark Vaccine purchase Uninsured adults Urgent vaccine needs

13 Public Health s Con(nuing Role in Immuniza(on Monitor impact and strengthen evidence base for vaccine policy & programs Improve access to quality immunization services Detect & respond to outbreaks of vaccinepreventable disease Prevention of disease Enhance partnership w/ community vaccinators & private providers Improve preparedness to deliver vaccines in public health emergencies Safely distribute public sector vaccines; manage vaccine supply disruptions and shortages Current priority issues for state and national focus Pertussis Resurgence Lagging HPV Coverage Rates Measles Importations and Outbreaks Short Window of Opportunity to Leverage EHR Revolution Vaccine Management and Quality Improvement

14 FY 2013 Sec(on 317 Report to Congress State and Local Opera(ons Stewardship and accountability for publicly purchased vaccine and Sec:on 317 and VFC opera:ons funding Assess program performance to drive program improvement Assure access to vaccines Assure that immuniza:on informa:on technology supports programma:c goals Strengthen and sustain preparedness for vaccina:on emergencies, including pandemics

15 Addi(onal Requirements Beginning in FY 2012: discussion of the evolving role of Federal programs as expanded coverage for vaccination becomes more available from private and public sources.

16 Considera(ons for Future Planning and Forecas(ng VFC Program dollars are majority of federal immunization resources Mandatory entitlement to eligible children Stable source of funding to meet vaccine need Restricted funding cannot meet urgent vaccine needs Discretionary Immunization funding is more complex and diverse Various funding streams with different requirements and reporting Majority of support for public health immunization infrastructure More flexible funding for program priorities and urgent vaccine needs Role of public health in evolving health insurance landscape