Agency Report Item 11: Oregon Health Authority Meningitis Vaccination Program in Lane County Analyst: Linda Ames Request: Acknowledge receipt of a report on the meningitis vaccination program in Lane County. Recommendation: Acknowledge receipt of the report. Analysis: The Oregon Health Authority (OHA) and the University of Oregon were directed to report on the meningitis vaccination program in the following budget note (SB 5507): The Oregon Health Authority, in collaboration with the Department of Consumer and Business Services, shall work with the University of Oregon on the vaccination program for meningitis. The Department of Consumer and Business Services shall ensure timely insurance coverage is covering appropriate costs for those with insurance. The Oregon Health Authority shall, within existing emergency preparedness funds, work with the University of Oregon on funding appropriate costs. The Oregon Health Authority and the University of Oregon shall report to the appropriate legislative committee the final cost of the program including any additional funding needs by December 2015 and any recommendations to ensure effective and efficient response to any future events. This report is just an update, since the outbreak response is ongoing and is expected to remain active until school ends in June 2016. The response involves the University of Oregon, OHA Public Health, Lane County Health Department, and Lane Community College, as well as the federal Centers for Disease Control and Prevention. The University of Oregon assumed the tasks and financial responsibilities associated with acquiring vaccine for its 22,000 undergraduate community, while Lane Community College did the same for at risk members of its community. The report includes background information and details about the processes that were followed. Two specific activities lowered the overall cost of the vaccinations: 1) the University of Oregon was successful in negotiating a price agreement with one of the two pharmaceutical companies that provide the vaccines, and 2) the Department of Consumer and Business Services was successful in working with most insurance companies to cover the vaccinations. The report contains limited data on numbers of students vaccinated. The report indicates that 20,129 vaccinations were reported to the ALERT Immunization Information System in OHA. However, a series of either two or three vaccinations are recommended, depending on the vaccine, so this represents far fewer than 20,000 students. In addition, some of the vaccinations may not have been reported to ALERT. While the report does not include any back up information on costs, the University of Oregon did provide additional information. Direct costs through October were $363,428 for University of Oregon, $24,150 for Lane Community College, $50,586 for Lane County Health Department, and $15,954 for OHA, for a total of $454,118. For the University of Oregon, most of this represents the Legislative Fiscal Office Interim Joint Committee on Ways and Means January 2016
cost of vaccines that have not been covered by insurance. In kind costs generally represent existing staff that were temporarily assigned to this effort. Over the next few months more vaccinations will be administered, and additional insurance payments are expected to come in. The final report later this year is expected to provide more complete information. Once the final cost information is available, the Legislature will have a number of options: 1) take no action and let each of the parties absorb their costs within their current budgets; 2) use part of the remaining General Fund emergency preparedness funding within Public Health to fund a part or all of the costs for the various parties; or 3) use resources from the Emergency Fund to fund a part or all of the costs. The Legislative Fiscal Office recommends acknowledging receipt of the report. Legislative Fiscal Office Interim Joint Committee on Ways and Means January 2016
11 Oregon Health Authority MacDonald Request: Report on the final cost of the vaccination program for the meningitis outbreak at the University of Oregon, including additional funding needs and recommendations. Recommendation: Acknowledge receipt of the report. Discussion: In mid-january 2015, an outbreak of bacterial meningitis occurred at the University of Oregon (UO). To date, this outbreak has resulted in seven confirmed cases of people contracting the disease, six of whom were UO undergraduate students. Of these six cases, one resulted in the death of a student in February 2015. The budget report for Senate Bill 5526 (2015) contains the following budget note requiring the Oregon Health Authority (OHA) and UO to report the final costs, funding needs, and recommendations related to the outbreak response efforts: The Oregon Health Authority, in collaboration with the Department of Consumer and Business Services, shall work with the University of Oregon on the vaccination program for meningitis. The Department of Consumer and Business Services shall ensure timely insurance coverage is covering appropriate costs for those with insurance. The Oregon Health Authority shall, within existing emergency preparedness funds, work with the University of Oregon on funding appropriate costs. The Oregon Health Authority and the University of Oregon shall report to the appropriate legislative committee the final cost of the program including any additional funding needs by December 2015 and any recommendations to ensure effective and efficient response to any future events. The submitted report provides a preliminary look at the costs of the outbreak because the response efforts remain on-going. Outbreaks can last up to a year after a case of bacterial meningitis is first diagnosed, and in this instance, the outbreak response efforts are expected to last until June 2016 to coincide with the end of the UO school year, as long as no additional cases are reported before then. The total cost reported for response efforts through November 1, 2015 was $787,342 for both direct and in-kind costs by UO ($511,428), Lane County Community College ($24,150), Lane County Health Department ($113,866), and OHA ($137,898). However, based on information provided after the report was submitted, UO indicated the amount it reported for in-kind costs was overstated by $75,270, bringing the revised total outbreak costs to $712,072. The total reported dollar amount does not reflect the meningitis vaccination costs covered by commercial insurers and, likewise, does not reflect the total cost resulting from the purchase of the vaccines due to a non-disclosure price agreement required by the vaccine producer. To this end, the most significant cost driver of the outbreak is the vaccination campaign, with the shared recommendation from the Centers for Disease Control and Prevention, OHA, and Lane County Public Health for UO to vaccinate all of its approximately 22,000 student population. However, the actual number of UO students vaccinated is not included in the submitted report primarily due to the non-disclosure price agreement for the vaccines and the inability to reconcile the multi-dosage requirements of the vaccine with the level of student detail available in the ALERT Immunization Information System. Department of Administrative Services 11-i January 15, 2016
The submitted report indicates that had the university purchased the required number of doses at the current market rate, the total cost would have been approximately $7.6 million to vaccinate all 22,000 students. With the assistance of the Department of Consumer and Business Services, OHA reports that in most cases insurers have agreed to cover the vaccination costs for insured students, thereby allocating an important part of the outbreak costs to the insurance industry. As the ongoing response efforts continue, the related costs will presumably increase. The submitted report, preliminary of final costs, makes no recommendation for cost reimbursement for the key outbreak response stakeholders. Department of Administrative Services 11-ii January 15, 2016