By: J. Nadine Gracia and Amy Pisani
January 21, 2020
When it comes to vaccine-preventable diseases in the United States, it’s been a rough few months. Flu season got off to its earliest start in 15 years and is currently widespread throughout the nation, according to the Centers for Disease Control and Prevention (CDC). Also, last year, the US narrowly missed losing its measles elimination status, with more cases reported in 2018 than in any single year since 1992. US cases of hepatitis A and hepatitis B are also on the rise, in part due to the opioid crisis. Whooping cough and mumps outbreaks are happening in schools across the country, and meningococcal disease is striking on college campuses.
The World Health Organization (WHO) has declared vaccines to be one of the most important public health interventions of the twentieth century, second only to clean water. Yet, we are seeing an increase in preventable infectious disease outbreaks, gaps in long-standing vaccine practices, and a growth in sociodemographic disparities in vaccination rates, particularly among children who live in rural areas or who are uninsured.
How To Turn The Tide
Solutions will require a renewed commitment to disease elimination, adequate funding, and enhanced bipartisan cooperation. To succeed, we must strengthen the public health infrastructure, renew confidence in vaccines, and increase access to immunizations. Fortunately, Congress is currently considering strong bipartisan, bicameral legislation that would take important steps forward including dealing with real-world impacts of vaccine hesitancy.
The public’s health has suffered due to a lack of adequate resources to promote vaccinations. Public health agencies from the CDC to the state, local, tribal, and territorial levels, lack the necessary infrastructure to guard against disease outbreaks including state-of-the-art case monitoring, and laboratory, communications, and vaccine distribution systems. This need to invest in infrastructure was recognized in both the Senate’s proposed Lower Health Care Costs Act and the House’s proposed Leading Infrastructure for Tomorrow’s America Act (LIFT America Act), which proposes grants to health departments to upgrade laboratory and health information systems.
In addition, to ensure that members of the public have confidence about the safety and effectiveness of vaccines, members of Congress have proposed the VACCINES Act of 2019, this act would authorize the CDC to: conduct extensive research to study what drives vaccine hesitancy and barriers to immunization; track changes in vaccination confidence, coverage, and refusal rates; predict where vaccines may be underutilized or where misinformation has been directed in a deliberate manner based on these data; and lead people to educational materials online, use media or in-person opportunities to combat misinformation, and increase both public understanding of the benefits of immunization and vaccination rates. The Lower Health Care Costs Act has similar language but does not include surveillance language. Trust for America’s Health and Vaccinate Your Family hope each bill will pass quickly, with sufficient appropriations to ensure the smooth implementation of these critical programs.
We must also ensure that the public has ready access to vaccines. That starts with comprehensive health insurance—for example, by expanding Medicaid coverage, continuing to guarantee no-cost preventive services, and addressing cost barriers that have long plagued Medicare beneficiaries. With regard to the latter, the Senate is currently considering the Protecting Seniors Through Immunization Act, which would ensure all vaccines are provided without cost sharing. If enacted, the bill would prevent the current situation in which Medicare fully covers only certain vaccines (such as the flu vaccine), while it allows cost sharing for others (such as the shingles vaccine).
Special action is needed to overcome the obstacles facing certain populations with less access to core health services such as people with low incomes or those living in rural areas. Historically, people of color have had lower insurance rates and less access to primary health services including vaccines.
One key way to overcome these obstacles is to increase funding for the CDC’s immunization program. While infection risks have risen, the CDC’s immunization line item has not. It has been funded at roughly the same level ($610 million) for nearly a decade. In an unpublished report to the US Senate Appropriations Committee, CDC officials estimate that full implementation of the immunization program requires a little more than $1 billion annually.
If that sounds like a lot of money, consider this: Vaccines given to children born in the US between 1994 and 2018 will prevent an estimated 419 million illnesses, 26.8 million hospitalizations, 936,000 deaths, and $1.9 trillion in total societal costs. For every dollar we spend on childhood immunization, we save $10.90.
No other medical intervention saves as much money.
We shouldn’t wait for another deadly outbreak to respond, not when we have effective tools that can save lives.