Financing the Delivery of Vaccines to Children and Adolescents: Challenges to the Current System

Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, 1600 Clifton Rd NE, Mail Stop E-52, Atlanta, GA 30333, USA.
PEDIATRICS (Impact Factor: 5.47). 12/2009; 124 Suppl 5(Supplement):S548-57. DOI: 10.1542/peds.2009-1542O
Source: PubMed


Recent increases in the number and costs of vaccines routinely recommended for children and adolescents have raised concerns about the ability of the current vaccine financing and delivery systems to maintain access to recommended vaccines without financial barriers. Here we review the current state of US financing for vaccine delivery to children and adolescents and identify challenges that should be addressed to ensure future access to routinely recommended vaccines without financial barriers. Challenges were considered from the perspectives of vaccine providers; state and local governments; insurers, employers, and other health care purchasers; vaccine manufacturers; and consumers.

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    • "The federal government created the VFC program in the Omnibus Budget Reconciliation Act of 1993 as a new Medicaid entitlement program. Under the program, implemented in 1994, pediatricians and clinicians are able to obtain pediatric vaccines at no charge to vaccinate children who are uninsured, Medicaid eligible, American Indian or Alaska Natives, or underinsured (Lindley, et al. 2009). 3 The vaccines provided under a VFC resolution are those recommended (either routinely or permissively) by the Advisory Committee on Immunization Practices (ACIP) to the CDC. "
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    ABSTRACT: The market for pediatric vaccines is unusual in that more than half are publicly provided through the federal Vaccines for Children (VFC) program. The CDC negotiates with vaccine manufacturers for the purchase of all pediatric vaccines supplied under the program, and given the size of its purchases buys at significant discounts off of list prices on a per-dose basis. In contrast, bundled discounts are in widespread use by multi-vaccine manufacturers for pediatric vaccines sold for private use. In this paper, we consider the competitive implications of the use of these bundled discounts, and whether the practice is at odds with the public health goals of ensuring a stable vaccine supply and encouraging the development of new and improved pediatric vaccines.
    SSRN Electronic Journal 01/2012; DOI:10.2139/ssrn.1978879
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    ABSTRACT: We compared (1) characteristics of adolescents who are and are not entitled to receive free vaccines from the Vaccines for Children (VFC) program and (2) vaccination coverage with meningococcal conjugate (MCV4), quadrivalent human papillomavirus (HPV4), and tetanus-diphtheria-acellular pertussis (Tdap) vaccines among VFC-eligible and non-VFC-eligible adolescents. We analyzed data from the 2009 National Immunization Survey-Teen, a nationally representative, random-digit-dialed survey of households with adolescents aged 13-17 years (n = 20,066). Differences in sociodemographic characteristics and provider-reported vaccination coverage were evaluated using t-tests. Overall, 32.1% (+/- 1.2%) of adolescents were VFC-eligible. VFC-eligible adolescents were significantly less likely than non-VFC-eligible adolescents to be white and to live in suburban areas, and more likely to live in poverty and to have younger and less educated mothers. Nationally, coverage among non-VFC-eligible adolescents was 57.1% (+/-1.5%) for > or = 1 dose of Tdap, 55.4% (+/-1.5%) for > or = 1 dose of MCV4, and 43.2% (+/- 2.2%) for > or = 1 dose of HPV4. Coverage among VFC-eligible adolescents was 52.5% (+/- 2.4%) for > or = 1 dose of Tdap, 50.1% (+/- 2.4%) for > or = 1 dose of MCV4, and 46.6% (+/- 3.5%) for > or =1 dose of HPV4. Only 27.5% (+/- 1.8%) of non-VFC-eligible adolescents and 25.0% (+/- 2.9%) of VFC-eligible adolescents received > or = 3 doses of HPV4. Vaccination coverage was significantly higher among non-VFC-eligible adolescents for Tdap and MCV4, but not for one-dose or three-dose HPV4. Conclusions. Coverage with some recommended vaccines is lower among VFC-eligible adolescents compared with non-VFC-eligible adolescents. Continued monitoring of adolescent vaccination rates, particularly among VFC-eligible populations, is needed to ensure that all adolescents receive all routinely recommended vaccines.
    Public Health Reports 01/2011; 126 Suppl 2:124-34. DOI:10.2307/41639292 · 1.55 Impact Factor
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    ABSTRACT: Following the measles outbreaks of the late 1980s and early 1990s, vaccination coverage was found to be low nationally, and there were pockets of underimmunized children primarily in inner cities. We described the percentage and demographics of children who were entitled to the Vaccines for Children (VFC) program in 2009 and evaluated whether Healthy People 2010 (HP 2010) vaccination coverage objectives of 90% were achieved among these children. We analyzed data from 16,967 children aged 19-35 months sampled by the National Immunization Survey in 2009. VFC-entitled children included children who were (1) on Medicaid, (2) not covered by health insurance, (3) of American Indian/Alaska Native race/ethnicity, or (4) covered by private health insurance that did not pay all of the costs of vaccines, but who were vaccinated at a Federally Qualified Health Center or a Rural Health Center. An estimated 49.7% of all children aged 19-35 months were entitled to VFC vaccines. Compared with children who did not qualify for VFC, the VFC-entitled children were significantly more likely to be Hispanic or non-Hispanic black; to have a mother who was widowed, divorced, separated, or never married; and to live in a household with an annual income below the federal poverty level. Mothers of VFC-entitled children were significantly less likely to have some college experience or to be college graduates. Of nine vaccines analyzed, two vaccines--polio at 91.7% and hepatitis B at 92.2%--achieved the HP 2010 90% coverage objective for VFC-entitled children, and four others, including measles-mumps-rubella at 88.8%, achieved greater than 80% coverage. Conclusions. Today, children with demographic characteristics like those of children who were at the epicenter of the measles outbreaks two decades ago are entitled to VFC vaccines at no cost, and have achieved high vaccination coverage levels.
    Public Health Reports 01/2011; 126 Suppl 2(Suppl 2):109-23. DOI:10.2307/41639291 · 1.55 Impact Factor
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