AVAC Letter on Fiscal Year 2023 Appropriations

April 6, 2022 


The Honorable Rosa DeLauro
House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies
Washington, DC 20515

The Honorable Tom Cole
Ranking Member
House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies
Washington, DC 20515

The Honorable Patty Murray
Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies
Washington, DC 20510

The Honorable Roy Blunt
Ranking Member
Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies
Washington, DC 20510

Dear Chairwomen DeLauro and Murray and Ranking Members Cole and Blunt: 

As members of the Adult Vaccine Access Coalition (AVAC), we write to ask for full funding of immunization-related activities at the Department of Health and Human Services as part of the fiscal year (FY) 2023 Labor, Health and Human Services (LHHS), and Education Appropriations bill.

The COVID-19 pandemic put a tremendous strain on our chronically underfunded public health infrastructure and exposed important weaknesses that simply must be addressed. It has also reminded us of the importance of health promotion and disease prevention efforts. Vaccines help mitigate disease, prevent severe illness, and reduce hospitalizations, morbidity, and mortality. 

Over the course of the pandemic, we have seen a precipitous drop in immunization rates across all ages, young and old. Before the pandemic, adult immunization rates were already below national targets, especially in underserved communities, where the risk of poor outcomes was highest. The pandemic only exacerbated these alarming trends.  A recent analysis conducted by Avalere Health revealed that adolescents and adults may have missed an estimated 37.1 million doses of recommended vaccines between December 2020 and July 2021 compared to the same time in 2019.1    

Routine immunization is core to public health, preventing billions of dollars in medical costs and lost productivity. Our nation cannot allow expanded vaccine access to erode as the public health emergency winds down. It is vital that our nation leverage the substantial progress and investments that have been made from the COVID-19 vaccination program. The opportunity we have before us today, is not just to return life course immunizations to pre-pandemic levels, but to build upon and exceed them.  

It is critical that the LHHS appropriations bill includes sustainable funding for immunization efforts, including long-term investments in immunization infrastructure, including immunization information systems, vaccine confidence campaigns, and support for health care providers. Immunizations are a sound investment because they are a highly cost-effective form of preventive medicine that help save lives by protecting the health and wellbeing of individuals and families in communities nationwide.  

AVAC strongly supports the President’s FY2023 budget as it proposes a substantial increase in the CDC immunization program that provides foundational support for state and local health department activities. The proposal supports not only COVID-19 vaccination, continue research related to long COVID-19 conditions and, support influenza programming, and enhance support in the human papilloma virus (HPV) vaccination efforts in alignment with the Administration’s Cancer Moonshot Initiative priorities. Since 2020, Congress made substantial emergency investments to ensure that all eligible individuals had access to the COVID-19 vaccine. It is imperative that Congress sustain these important investments beyond the immediate threats of the pandemic to help transition our Nation to a sustainable program to support not only COVID-19 vaccination but also supporting recovery of routine childhood, adolescent and adult vaccination that have been missed. The President’s FY2023 budget also proposes an immunization program that is focused on the long-neglected needs of the adult population. This program would go a long way toward addressing access, education and outreach and continuing to encourage more providers across the health care continuum to make immunization a routine part of their clinical workflow for all adult patients. 

We ask the Committee to strongly support: 

$1.13 billion to fully fund the National Immunization Program at the Centers for Disease Control and Prevention (CDC)’s National Center for Immunization and Respiratory Diseases (NCIRD)(+$400m). The immunization program at CDC provides funding to state and local health departments to carry out a variety of activities vital to the prevention, detection, and mitigation of vaccine-preventable conditions. These essential grants are utilized not only for the purchase of vaccines, but also support a number of other important activities, including: surveillance, safety and effectiveness studies, education and outreach, implementation of evidence-based community interventions to increase immunization coverage among underserved and high-risk populations, and vaccine-preventable disease outbreak response. The resources provided under the immunization program are vital to communities across the country, many of whom rely solely on these funds to support their immunization activities.   

Establishment of the Vaccines for Adults Program (VFA).  We wish to express support for the newly proposed Vaccines for Adults Program, which seeks to provide uninsured adults with access to all vaccines recommended by the Advisory Committee on Immunization Practices at no cost. This new program would create a life course approach to immunization, by complementing the longstanding success of the Vaccines for Children Program (VFC). To ensure all Americans have access to recommended vaccines, we continue to support expansion of existing coverage programming, including the elimination of Financial Barriers in Medicare Part D and Medicaid. 

$251 million for Influenza Planning and Response at CDC’s NCIRD (+$50m). CDC’s Influenza Planning and Response programs help to protect the United States from seasonal influenza and pandemic influenza. Each winter, influenza causes millions of illnesses and hundreds of thousands of hospitalizations. Providing $241 million for the program will ensure CDC has the resources necessary to address the continual threats posed by seasonal and pandemic influenza. 

$140 million for CDC’s Division of Viral Hepatitis (+$94.5m). The National Viral Hepatitis Strategic Plan has for the elimination of hepatitis A, B, and C as public health threats in the United States. HAV and HBV have a safe and highly effective vaccine that can prevent infection. In 2021 Advisory Committee Immunization Practices (ACIP) made a paradigm shift from a risk-based recommendation to a routine recommendation that all adults between 19 and 59 be vaccinated for hepatitis B. Currently, only 25% of adults are vaccinated for HBV.  Chronic HBV requires life-long medical care, as there is no cure. With this new recommendation there is an opportunity to take us closer to the elimination of hepatitis B but will need improved funding to implement that important routine recommendation.  Providing $140 million will be essential to expand adoption of recommendations for HBV and HCV testing, HBV vaccination, and linkage to care. 

$12.7 million for the Office of Infectious Disease and HIV/AIDS Policy (OIDP) (+$5m). OIDP plays a vital role in directing and implementing HHS and federal government-wide policies, programs, and activities related to vaccines and immunization. This portfolio includes providing policy leadership, outreach and coordination on vaccine and immunization-related activities among federal agencies and non-federal stakeholders, implementation of Vaccines National Strategic Plan, and coordination of the National Vaccine Advisory Committee.  Funds These funds will be essential in securing full implementation of the National Vaccine Strategic Plan, a comprehensive roadmap in the development and use of vaccines across the life course in the United States.  

We look forward to working with your office as the FY23 appropriations process gets underway. For further information, please contact the AVAC managers at info@adultvaccinesnow.org. 


Alliance for Aging Research
American Academy of Family Physicians 
American College of Preventive Medicine 
American Heart Association
American Immunization Registry Association
American Pharmacists Association 
American Public Health Association
Asian & Pacific Islander American Health Forum
Association for Professionals in Infection Control and Epidemiology
Association of Asian Pacific Community Health Organizations (AAPCHO)
Association of Immunization Managers
Association of Maternal & Child Health Programs
Association of Occupational Health Nurses 
Association of State and Territorial Health Officials 
Biotechnology Innovation Organization
Families Fighting Flu
Hep B United
Hepatitis B Foundation 
Hepatitis Education Project 
Immunization Coalition of Washington, DC 
Infectious Diseases Society of America 
Johnson & Johnson
March of Dimes
Merck & Co Inc.
National Association of City and County Health Officials
National Association of Nutrition and Aging Services Programs (NANASP) 
National Black Nurses Association
National Consumers League
National Foundation for Infectious Diseases
National Hispanic Medical Association 
National Minority Quality Forum
National Viral Hepatitis Roundtable 
STC Health
The AIDS Institute
The Gerontological Society of America
Trust for America’s Health
Vaccinate Your Family
Valneva USA
VBI Vaccines Inc.
WomenHeart: The National Coalition for Women with Heart Disease 


Cc: House Appropriations Committee 

      Senate Appropriations Committee