Angela K. Shen

Financing the delivery of vaccines to children and adolescents: Challenges to the current system

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.

Financing vaccination of children and adolescents: National Vaccine Advisory Committee recommendations

Increases in the number and cost of vaccines routinely recommended for children and adolescents have raised concerns about the ability of the current systems for vaccine financing and delivery to ensure that all children and adolescents have access to all routinely recommended vaccinations without financial barriers. The National Vaccine Advisory Committee (NVAC) was chartered in 1988 to advise and to make recommendations to the director of the National Vaccine Program and the Assistant Secretary for Health at the US Department of Health and Human Services on matters related to the prevention of infectious diseases through vaccination. In October 2006, NVAC established a Vaccine Financing Working Group to explore approaches for child and adolescent vaccine financing. The Vaccine Financing Working Group was charged with establishing a process for obtaining stakeholder input regarding challenges to creating optimal approaches to vaccine financing in both the public and private sectors. The goal of this process was to develop recommendations to ensure that all children and adolescents have access to all routinely recommended vaccinations without financial barriers.

Applying lessons learned from the USAID family planning graduation experience to the GAVI graduation process

As low income countries experience economic transition, characterized by rapid economic growth and increased government spending potential in health, they have increased fiscal space to support and sustain more of their own health programmes, decreasing need for donor development assistance. Phase out of external funds should be systematic and efforts towards this end should concentrate on government commitments towards country ownership and self-sustainability. The 2006 US Agency for International Development (USAID) family planning (FP) graduation strategy is one such example of a systematic phase-out approach. Triggers for graduation were based on pre-determined criteria and programme indicators. In 2011 the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunizations) which primarily supports financing of new vaccines, established a graduation policy process. Countries whose gross national income per capita exceeds

Strengthening the U.S. Vaccine and Immunization Enterprise: The Role of the National Vaccine Advisory Committee

1570 incrementally increase their co-financing of new vaccines over a 5-year period until they are no longer eligible to apply for new GAVI funding, although previously awarded support will continue. This article compares and contrasts the USAID and GAVI processes to apply lessons learned from the USAID FP graduation experience to the GAVI process. The findings of the review are 3-fold: (1) FP graduation plans served an important purpose by focusing on strategic needs across six graduation plan foci, facilitating graduation with pre-determined financial and technical benchmarks, (2) USAID sought to assure contraceptive security prior to graduation, phasing out of contraceptive donations first before phasing out from technical assistance in other programme areas and (3) USAID sought to sustain political support to assure financing of products and programmes continue after graduation. Improving sustainability more broadly beyond vaccine financing provides a more comprehensive approach to graduation. The USAID FP experience provides a window into understanding one approach to graduation from donor assistance. The process itself-involving transparent country-level partners well in advance of graduation-appears a valuable lesson towards success.

The National Adult Immunization Plan

Address correspondence to: Angela K. Shen, MPH, National Vaccine Program Office, Department of Health and Human Services, 200 Independence Ave. SW, 717H, Washington, DC 20201-0004; tel. 202-690-5566; fax 202-690-4631; e-mail . The National Vaccine Advisory Committee (NVAC) is a federal advisory committee that provides vaccine and immunization policy recommendations to the U.S. Department of Health and Human Services (HHS). The NVAC’s diversity of professional and stakeholder perspectives enables the committee to play a role in strengthening the U.S. vaccine and immunization system, as well as inform vaccine policy. This article details the NVAC’s contribution, focusing on its recent response to the 2009 H1N1 pandemic, and reveals opportunities for the NVAC to further shape this public health sector in the future.

Financial impact to providers using pediatric combination vaccines.

Introduction Despite the widespread availability of safe and effective vaccines, adult vaccination rates remain low in the U.S. and far below Healthy People 2020 targets. Vaccine-preventable diseases exert a heavy toll on adults aged 18 years and older. The Centers for Disease Control and Prevention estimates that among U.S. adults, each year there are roughly 40,000 cases and 4,000 deaths attributable to invasive pneumococcal disease, between 3,000 and 49,000 deaths due to seasonal influenza, 9,000 reported cases of pertussis, approximately 3,000 reported cases of acute hepatitis B, and about 1 million cases of herpes zoster. The costs associated with these diseases and their sequelae are substantial. The health and productivity costs of influenza alone are estimated to be as high as

How might immunization rates change if cost sharing is eliminated

87 billion per year. Low vaccination rates in adults leave them vulnerable to vaccine-preventable diseases and their complications. This has been seen in recent epidemics, such as the 2015 measles outbreak, when adults accounted for more than half of all cases. The consequences of not being vaccinated, however, do not just impact individuals directly. Unvaccinated adults contract and spread vaccine-preventable diseases to others, including children who are too young to be immunized and those who cannot be immunized for medical reasons, such as compromised immune systems. With the aging of the U.S. population, the public health importance of adult immunization (for adults as well as their wider communities) will continue to grow. The Centers for Disease Control and Prevention and its Advisory Committee on Immunization Practices, a federal advisory committee that provides external expert

Receipt of other routinely recommended vaccines relative to receipt of seasonal influenza vaccines: Trends from medicare administrative data, 2013–2015

OBJECTIVE: To understand the financial impact to providers for using a combination vaccine (Pediarix [GlaxoSmithKline Biologicals, King of Prussia, PA]) versus its equivalent component vaccines for children aged 1 year or younger. METHODS: Using a subscription remittance billing service offered to private-practice office-based physicians, we analyzed charge and payment information submitted by providers to insurance payers from June 2007 through July 2009. We analyzed provider and payer characteristics, payer comments, and the ratio of vaccine product to immunization administration (IA) codes and computed total charges and payments to providers for both arms of the study. RESULTS: Most providers in our data set were pediatricians (74%), and most payers were commercial (75%), primarily managed care. The ratio of the number of vaccine products to the number of IAs was 1:1 in the majority of the claims. Twenty percent of claims were paid with no adjustment by the payer, whereas 76% of the claims were adjusted for charges that exceeded the contract arrangement or the fee schedule. Providers received

Driving immunization through the Medicare Annual Wellness Visit: A growing opportunity

23 less from commercial payers and

Beneficiary characteristics and vaccinations in the end-stage renal disease Medicare beneficiary population, an analysis of claims data 2006–2015

13 less from Medicaid for the use of Pediarix compared with the equivalent component vaccines. The mean commercial payment was greater for age-specific Current Procedural Terminology IA codes 90465 and 90466 than for non–age-specific codes 90471 and 90472, whereas the reverse was true for Medicaid. CONCLUSIONS: Providers who administer vaccines to children face a reduction in payment when choosing to provide combination vaccines. The new IA codes should be monitored for correction of financial barriers to the use of combination vaccines.