Supporting State and Local Immunization Programs Brock A. Lamont, MPA Chief, Program Operations Branch Immunization Services Division

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1 Supporting State and Local Immunization Programs Brock A. Lamont, MPA Chief, Program Operations Branch Immunization Services Division Texas Immunization Summit 2014 November 6, 2014 San Antonio, TX

2 I do not have any relevant conflicts of interest to disclose.

3 Immunization in the US Most vaccine-preventable diseases at record lows Achieved & sustained high childhood immunization Reduced disparities in childhood coverage Introduced multiple new vaccines

4

5 Cost to Vaccinate One Child with Vaccines Universally Recommended from Birth Through 18 Years of Age: 1990, 2000, and 2013 $2,000 $1,800 $1,600 $1,400 $1,723 3 HPV 2 rotavirus 2 hep A 2 MCV $1,200 $1,000 $800 $600 $400 $370 1 Tdap 20 flu 4 PCV13 2 varicella 3 hep B 3 Hib 2 MMR $200 $70 $ represents minimum cost to vaccinate a child (birth through 18); exceptions are 1) no preservative influenza vaccine, and 2) HPV for males and females. Federal contract prices as of February 1, 1990, September 27, 2000, and November 18, polio 5 DTaP

6 VFC & Discretionary Immunization Funding FY FY 2013 $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 VFC PPHF ARRA Program Operations Section 317 $500,000,000 $0

7 Pediatric Vaccines Recommended for Children 0-6 Years of Age Doses Distributed by Funding Source Calendar Year 2012 Source: Biologics Surveillance Data Represents a national summary of self-reported distribution data by the vaccine manufacturers. The data are an estimate of the annual national distribution and does not equal administration. Reported data may be incomplete and include possible over-reporting or under-reporting of distribution data and may not reflect all vaccines or manufacturers. Other represents all purchases not on CDC contracts, including private, health insurance, and government purchases through other mechanisms. A proportion of MMR, Varicella and PCV13 vaccines may be utilized in adults older than age 18 years. Data do not include influenza vaccine doses. Updated December 12, 2013

8 Public Health s Role in Immunization 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

9 CDC s Immunization Priorities Preserve core public health immunization infrastructure at local, state, and federal levels Make strategic investments to modernize immunization 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 FY14 President s Budget

10 Selected Milestones in the Changing Immunization Landscape for State Programs Centralized Distribution 2010 Affordable Care Act VTrckS Rollout 2012 OIG Report: VFC Vaccine Storage and Handling Section 317 vaccine use policy 2013 New Immunization CoAg State vaccine purchase policy Lapse in federal appropriation

11 VFC and 317 Cooperative Agreement Purpose is to support efforts to plan, develop, and maintain a public health workforce that: assures high immunization coverage levels; assures low incidence of vaccine-preventable diseases; and maintains or improves the ability to respond to public health threats. The FOA directly supports Healthy People 2020 Objectives. CDC-RFA-IP , CFDA # &

12 Cooperative Agreement (Continued) 64 awardees (61 VFC awardees) Award approximately $215M in 317 program operations funding, approximately $80M in VFC funding and approximately $15M in Panflu Awardees are made in multiple rounds (generally two three) over the course of the calendar year In 2013 switched to a Cooperative Agreement funding mechanism

13 Program Operational Components Areas of Focus Program Stewardship and Accountability Assessing Program Performance Assuring Access to Vaccines Immunization Information Technology Infrastructure Improve and Maintain Preparedness

14 Current Challenges and Opportunities Preserve core public health immunization infrastructure Improve vaccine handling and inventory management Immunization Information Systems and Health IT (EMRs, Health Information exchanges, etc.) Address lagging vaccine indicators (e.g., HPV in teens) Harnessing the immunization neighborhood Pharmacies, work places, community sites, medical homes

15 Impacts of the Economic Crisis Budget Cuts: Fifty agencies (46 states, 3 territories, and Washington, DC) have reported budget cuts since July 2008, based on the results of the ASTHO Budget Cuts Surveys. Reduced Work Force Capacity and Programs States and territorial health agencies (SHAs) continue to experience budget cuts and job losses, resulting in the reduction or elimination of critical public health programs and services (Table 1). ASTHO Research Briefs (2012), Budget Cuts

16 Number of Job Losses in Central and Local/Regional Offices by Fiscal Year Number of Job Losses in Central and Local/Regional Offices by Fiscal Year Central Local/Regional Total FY09 1, ,700 FY10 1, ,650 FY11 1, ,700 FY12 1, ,750 TOTAL 6,350 3,450 9,800 Since July 2008, 91% of all SHAs have experienced job losses through a combination of layoffs and attrition. Approximately 9,800 state jobs have been lost in central, local, and regional offices. More than half (58%) of all health agencies imposed furloughs since FY10. ASTHO Research Briefs (2012), Budget Cuts, Table 1.

17 Vaccine Storage and Handling 2012 OIG Report The report highlighted some areas for improvement and underscores the importance of maintaining a robust public health system Identified two types of findings: Storage and Handling of Vaccine Program Management Issues General recommendations from the report include: Ensure vaccine storage and handling in accordance with VFC requirements Enhance processes for handling expired vaccines Improve management of vaccine inventories Ensure oversight requirements For more information, please visit

18 Vaccine Storage and Handling Role of CDC Develop recommendations for best practices related to vaccine storage and handling (Vaccine Storage and Handling Toolkit) Develops VFC program requirements related to vaccine storage and handling for awardees and providers Provides training and technical assistance on vaccine storage and handling Identifies knowledge gaps related to vaccine storage and handling and conducts/supports research and evaluation to address gaps Manages cold chain for public vaccine supply chain from CDC s central vaccine distributor until delivery at the provider Role of State/Local Immunization Programs Implements VFC requirements and other state program requirements for vaccine storage and handling Educates providers about vaccine storage and handling recommendations and requirements Monitors provider activities around vaccine storage and handling

19 What kind of refrigerator should I use? Household, consumer-grade units Pharmaceutical-grade units Freezerless Dual-zone Under-the- counter Full-sized Dual-zone unit is acceptable for refrigerated vaccine storage only do not use freezer compartment

20 Vaccine Storage Methods and Locations DUAL ZONE DANGER! FREEZE RISK: top shelf is 2 5 C colder than center of unit PHARMACEUTICAL FREEZERLESS Avoid storing on top shelf near cooling vent. First location to exceed max allowed temp during outages. 1 2 C warmer than center shelves. Thermally-isolated drawers are less accessible, may increase door open time Manufacturer recommends no floor storage, but vial TC maintained at 2 8 C throughout testing 1 2 C colder than main fridge space Best storage practice place vaccines in center fridge space, contained in original packaging, cardboard boxes, and/or plastic trays to minimize thermal excursions

21 The HPV vaccine is an anti-cancer vaccine Reduction in prevalence of vaccine-type HPV by 56% in girls age with vaccination rate of ~30% (compare with 80% rate in Rwanda) Our low vaccination rates will lead to 50,000 girls developing cervical cancer that would be prevented if we reach 80% vaccination rates For every year we delay increasing vaccination rates to this level, another 4,400 women will develop cervical cancer Markowitz et al. JID 2013;208:

22 CDC Focus Areas for Improving HPV Vaccine Coverage Mobilize partners and stakeholders Strengthen providers commitment and recommendation Increase public awareness of HPV vaccine as cancer prevention Address vaccine safety concerns at every opportunity Focus on high priority states Use systems approaches to improve vaccine coverage

23 Vaccines Don t Give Themselves Building and maintaining the public-private partnership of immunization providers Quality assurance Provider education Immunization information systems Providing evidence-based immunization policy Understanding disease burden Vaccine risks and benefits Knowing how we are doing Surveillance for disease and for safety Surveillance for coverage Fostering multi-sector partnerships and coalitions to broaden access and awareness Responding to protect public health

24 Twitter on Twitter is a leading source for health care providers on immunization training, recommendations, and information across the lifespan.

25 Questions?

I do not have any relevant conflicts of interest to disclose.

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