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Draft  2/16/10

Recommendation to maintain and preserve state and local public health department vaccination infrastructure created in response to the 2009 H1N1 pandemic influenza.

Following a motion made by Dr. James Mason at the meeting of the National Vaccine Advisory Committee (NVAC) on February 4, 2010 which was tabled, the following revised motion was written.  It recommends that the Assistant Secretary for Health (ASH) undertake efforts to maintain and preserve state and local public health department vaccination infrastructure created in response to the 2009 H1N1 influenza pandemic.  This recommendation was adopted by the NVAC during its February 26, 2010 public teleconference meeting.  It will be transmitted to the ASH for his review and consideration of options for implementation.

The NVAC has been a strong proponent of developing and maintaining public health infrastructure for state and local health departments to support vaccination.  For example, two of the recommendations on vaccine financing approved by the NVAC in September 2008, directly address funding for vaccination program infrastructure.  Recommendation #14 states “Congress should request an annual report on the CDC’s professional judgment of the size and scope of the Section 317 program appropriation needed for vaccine purchase, vaccination infrastructure, and vaccine administration.  Congress should ensure that Section 317 funding is provided at levels specified in CDC’s annual report to Congress.”  Recommendation #19 states “Congress should expand Section 317 funding to support the additional national, state and local public health infrastructure (e.g., widespread and effective education and promotion for healthcare providers, adolescents, and their parents; coordination of complementary and alternative venues for adolescent vaccinations; record keeping and immunization information systems; vaccine safety surveillance; disease surveillance) needed for adolescent immunization programs as well as childhood vaccination programs for new recommendations such as universal influenza vaccine.”  Unfortunately, the current public health infrastructure is even less evolved when it comes to delivering vaccines to the non-pediatric population, and no basic infrastructure exists to provide vaccines to adults in the United States. 

The H1N1 influenza pandemic occurred at a time when many state and local health departments were experiencing unprecedented financial challenges.  In the absence of a developed vaccine delivery infrastructure and to respond to the H1N1 influenza pandemic, funding was provided to states through the Public Health Emergency Response (PHER) grant program, to a potential total of $1, 944,000,000.  These funds were used, in part, to support vaccine and vaccination functions.  These included state and local health department staff and resources for:  1) health care provider relations around enrollment and delivery of vaccinations, 2) health care provider education, 3) enhanced vaccine ordering systems, 4) management of  state and county-level vaccine inventories, 5) establishment and enhancement of systems for accounting for vaccine doses administered,  6) vaccine safety monitoring (including, in some states, participation in the PRISM project to develop links between immunization information systems and insurance claims data for vaccine safety outcomes), 7) support for conducting vaccine points of distribution (PODs) and school-located vaccination programs, and 8) enhanced laboratory and epidemiology capacity to support vaccination efforts.  However, the funding through PHER grants is temporary, with budget periods ending by July 2010.   

The response to the pandemic and the financial support led to important improvements in public health response capacity.  For example, outreach to providers to encourage registration for the H1N1 influenza vaccine distribution system yielded 120,000 completed provider agreements, with many completed by providers who did not routinely vaccinate prior to the pandemic.  More than 77,000 individual ship-to sites were utilized for vaccine distribution.  These efforts were supported by many newly hired staff for whom substantial investments in training were made. 

With the loss of these funds, gains in infrastructure and the ability to maintain a stable, well-trained workforce will be lost, and the erosion of public health capacity will continue.  This will leave gaps in both the ability to respond to potential new emerging threats as well as the routine activities of immunization programs.  The situation will be exacerbated by the proposed reduction in Federal Section 317 funds for vaccination infrastructure grants to state and local health departments of 13 million dollars in the President’s Fiscal Year 2011 budget.  The FY2011 budget appropriates 221 million dollars for Section 317 infrastructure grants, much lower than the PHER funding levels.

Resolved: The NVAC recommends that the Assistant Secretary for Health work with the Secretary of the Department of Health and Human Services (HHS) and other Assistant Secretaries in HHS to identify ways to preserve and maintain the critical improvements in state and local public health department vaccination infrastructure created in response to the 2009 H1N1 influenza pandemic.