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Is the National Vaccine Plan’s Vision for Immunization Infrastructure a Brave New World for Immunization?

LJ Tan, MS, PhDDr. LJ Tan
Chief Strategy Officer, Immunization Action Coalition
Co-Chair, National Adult Immunization Summit and National Influenza Vaccine Summit

Since the National Vaccine Plan was published, the National Vaccine Program Office, in implementing the Plan, has wisely encouraged and welcomed collaboration with external partners. The National Adult and Influenza Immunization Summit (NAIIS) serves as a wonderful example of the trusted collaboration that can result from external partnerships. Indeed, NAIIS is part of a responsive framework which now exists to not only connect the efforts of the agencies within the federal government, but also to connect the federal government with multiple external partners, through which activities to improve immunization objectives can be identified and accomplished.

Through Goal 4 of the National Vaccine Plan, which is focused on the nation’s immunization infrastructure, the country has significantly improved its ability to monitor immunization coverage and vaccine effectiveness, as well as survey for vaccine preventable diseases. Recognizing the diversity of the adult population and adult vaccination providers, National Vaccine Advisory Committee (NVAC) has updated its Standards for Adult Immunization Practice to emphasize the responsibility of ALL providers of adult care to assess for, strongly recommend and provide appropriate vaccines, or refer the adult to a provider who immunizes. Our ability to detect and respond to outbreaks has been tested with pertussis and measles, and Hib disease outbreaks and the system has responded admirably. However, as pointed out in the recent NVAC report on the 317 program, the immunization infrastructure is fragile as a result of a lack of resources and from funding cuts, and we must commit resources and continue collaboratively to maintain this delicate system.

The implementation of the Affordable Care Act will play an important role in the elimination of financial barriers to immunizations for patients. Indeed, no-cost access to recommended vaccines will be much improved, especially for privately insured persons and those covered under expanded Medicaid.  The NAIIS and others have worked to increase awareness among providers and the public about the impact of the Affordable Care Act, but continued education is necessary. Challenges remain, including persistent confusion about vaccine coverage within the Affordable Care Act. Additionally, the need to improve access points to vaccines for a large number of newly-eligible persons will stress the infrastructure. Vigilance is necessary to ensure the adequacy of payment to all providers of immunization services, especially as the Affordable Care Act improves access.

As we improve the immunization infrastructure, an adequate vaccine supply is necessary.  More significantly, we need to be able to determine the status of vaccine supply at any given time.  As the National Vaccine Plan is implemented, we must continue to respect the importance of our vaccine manufacturers, and to support continued research and development into new vaccines. NVPO’s collaboration with the Institute of Medicine to prioritize vaccines for research and development is an excellent starting point.

Integration of Immunization Information Systems (IIS) into Electronic Health Records (EHRs) is necessary to improve assessment, administration, and documentation of immunizations. Perhaps more importantly, this important component of our infrastructure will allow us to measure the outcomes from our immunization efforts.  As immunizations, particularly for adults, are provided at multiple access points, the ability to record immunizations received into an integrated system is critical. If meaningful use is successfully implemented, health systems, providers, patients, and public health will be able to harness the data from IIS and EHRs to improve immunization activities.

In conclusion, the remarkable health and cost benefits that we have achieved in immunization can only be advanced if the nation values the immunization infrastructure that is its foundation. As a country we need to commit the resources (financial and otherwise) necessary to advance the bold vision of Goal 4 of the NVP and the progress it promises. In addition, it is imperative that the existing critical, but often invisible, immunization infrastructure not collapse as a result of lack of funding or political will. Should this happen, the public will lose the hard fought gains in immunizations that we have accomplished.