Expanding Current Vaccine Programs Proposed

The government should be the sole distributor of vaccines, one expert argues

WEDNESDAY, July 22, 2005 (HealthDay News) -- Last year's flu vaccine shortage has spurred concerns about the nation's vaccine supply, and various groups have proposed different solutions to this mounting problem.

The recommendations of two key players on opposite sides of the fence are debated in the July issue of the American Journal of Preventive Medicine.

The debate begins not a moment too soon: Chiron Corp. announced last week it would only be able to manufacture 18 million to 26 million doses of its Fluvarin vaccine for the 2005-2006 season. Before the unexpected closure of its British plant last fall, the company had planned to produce some 50 million doses -- about half of the supply ordered by the United States. Meanwhile, the federal government is considering applications from other vaccine makers to sell their product in this country next fall.

The Institute of Medicine (IOM) has recommended a system in which health care insurers would be mandated to cover all immunizations. They also recommended that the government subsidize the purchase of vaccines and create a voucher system for those without health insurance.

In contrast, the Vaccine Financing Workgroup of the National Vaccine Advisory Committee (NVAC) suggests that the way to fix the problem is by expanding and funding the existing immunization grant programs, such as Vaccines for Children and Medicare, to cover all children, adolescents and adults.

"The NVAC was asked to respond to the recommendations from the Institute of Medicine about financing vaccines," said report author Dr. Alan R. Hinman, a senior public health scientist at the Public Health Informatics Institute and Task Force for Child Survival and Development.

Hinman noted that part of the problem of financing vaccines is the fact that manufacturers have left the business because they do not view vaccines as profitable. Thus, there are problems in making sure that everyone who needs a particular vaccine gets it.

Regarding the IOM recommendations, Hinman said they are a radical change. "We did not feel that the recommendations of the IOM were the best course to follow," he said. "We believe that modifications of the system can substantially improve the situation."

The current system includes a grant program, called the Vaccination Assistance Act, which has been in place for more than 40 years. This statute provides for the purchase of vaccines and for giving vaccines in public clinics. There is also a program that has been in place for 10 years, called Vaccines for Children, which provides free vaccines for children who are uninsured, or to populations that are on Medicaid or whose insurance doesn't cover vaccinations, Hinman noted.

"We believe that expansion and strengthening of these programs would make a big difference and would really help stabilize financing for vaccines in the United States," Hinman said. "These programs have worked very well. We have the highest levels of immunization we have ever had in children, and that has been a result of the programs we currently have."

The problem, according to Hinman, is that as new and more expensive vaccines become available, the Congressional appropriations process for the Vaccination Assistance Act lags behind the introduction of new vaccines. However, for private insurance and the Vaccines for Children program, new vaccines are made available immediately.

"There is a very uncomfortable period where health departments find they can provide vaccines to children who are eligible for Vaccines for Children, but they don't have funds to purchase vaccines to give to others," Hinman noted.

Hinman also said that plans such as those in Europe where governments are the sole buyer of vaccines are viewed by vaccine manufacturers as "advanced price fixing," and his group is opposed to the practice.

"Vaccines remain one of our best means of preventing disease," Hinman said. "We need to strengthen our system of financing vaccines, and this can best be done by strengthening and expanding our existing mechanisms."

One expert disagrees with both the IOM and the NVAC recommendations.

"We need a revamping of the system of production and administration of vaccines in this country," said Dr. Marc Siegel, an associate professor of medicine at the New York University School of Medicine.

"Under the current system there is no assurance that we are going to have the right number of vaccines, or that the distribution will be to the right people," Siegel said. "Sprucing up the existing system isn't going to work. There are many worldwide examples of better systems."

There needs to be a larger pool of vaccine manufacturers, and there needs to be government regulation to make sure the vaccine gets made and gets delivered to the high-risk groups, Siegel said.

"Things would work better if the government were the main distributor of vaccines," he said. "Vaccination is a social necessity. I don't think it should be left to the manufacturer."

More information

The CDC can tell you more about vaccinations.

SOURCES: Alan R. Hinman, M.D., M.P.H., senior public health scientist, Public Health Informatics Institute, Task Force for Child Survival and Development, Decatur, Ga.; Marc Siegel, M.D., associate professor, medicine, New York University School of Medicine, New York City; July 2005 American Journal of Preventive Medicine
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