FY 2024 Annual Performance Plan and Report - Strategic Goal 2: Objective 2.2

Fiscal Year 2024
Released March, 2023

Topics on this page: Objective 2.2: Protect individuals, families, and communities from infectious disease and non-communicable disease through equitable access to effective, innovative, readily available diagnostics, treatments, therapeutics, medical devices, and vaccines | Objective 2.2 Table of Related Performance Measures

Objective 2.2: Protect individuals, families, and communities from infectious disease and non-communicable disease through equitable access to effective, innovative, readily available diagnostics, treatments, therapeutics, medical devices, and vaccines

HHS is working on strategies to protect the public from known and emerging infectious diseases and prevent non-communicable diseases, including cardiovascular diseases, cancer, diabetes, and other chronic conditions.  HHS advances the development and delivery of safe and effective, and innovative diagnostics, treatments, therapeutics, medical devices, and vaccines.  HHS invests in innovative technology and development to ensure the supply and availability of diagnostics, treatments, therapeutics, medical devices, and vaccines while leveraging resources and collaborations to support and apply research, evaluation, and data insights about non-communicable and infectious disease.

The Office of the Secretary leads this objective.  The following divisions are responsible for implementing programs under this strategic objective: AHRQ, ASPR, CDC, CMS, FDA, HRSA, IHS, NIH, OASH, and OGA.  In consultation with OMB, HHS has determined that performance toward this objective has made noteworthy progress.  The narrative below provides a brief summary of progress made and achievements or challenges, as well as plans to improve or maintain performance.

Objective 2.2 Table of Related Performance Measures

In the United States, on average 5 to 20 percent of the population contracts the flu, more than 200,000 people are hospitalized from seasonal flu-related complications, and approximately 36,000 people die from seasonal flu-related causes.  It is important that everyone over 6 months old receives an annual flu shot. This measure reflects the universal influenza vaccination recommendation and aligns with the Advisory Committee on Immunization Practices’ updated recommendation (as of 2010) for the seasonal influenza vaccine.  Seasonal influenza vaccination rates for adults aged 18 and older increased slightly over the past few years from 45 percent in FY 2018 to 49 percent in FY 2021, with FY 2021 vaccination rates seeing little change from FY 2020 .  Targets for this measure have remained level for several years as CDC works to achieve the current level of seasonal flu vaccination.  Interpretation of these results should take into account limitations of the survey, which include reliance on self-reporting of vaccination status and a decrease in response rates.

While the most recent data shows a slight improvement, flu vaccination coverage among adults remains at about 5 in 10 adults reporting receipt of a flu vaccination.

CDC's continuing efforts to improve adult vaccination coverage rates include:

• Increasing patient and provider education to improve demand and implement system changes in practitioner office settings to reduce missed opportunities for vaccinations.
• Funding state and local health departments to implement the Standards for Adult Immunization Practice in large health care systems, community health centers, pharmacies, and other settings.
• Partnering with professional organizations (e.g., F1.3 American Pharmacists Association, American College of Physicians, American Academy of Family Physicians, American College of Obstetricians and Gynecologists) and other organizations (e.g., National Association of Chain Drug Stores, National Association of Community Health Centers, American Immunization Registry Association) to develop and implement strategies to improve adult immunization at provider, practice, and systems levels.
• Enhancing evidence-based communication campaigns to increase public awareness about adult vaccines and recommendations.  CDC routinely conducts literature reviews and surveys of the general public and healthcare providers to provide a deeper understanding of the target audiences for development of adult immunization communication messages and campaigns.
• Partnering with the National Adult and Influenza Immunization Summit, a national coalition of partners and stakeholders represented by clinicians, public health, industry, government, and other entities with the common goal to promote immunization for adults.
• Expanding the reach of vaccination programs including new venues such as pharmacies and other retail clinics.  CDC has existing partnerships to implement adult immunization practice standards, HPV vaccination, and pandemic vaccine program planning efforts to expand access to pandemic vaccine.  As of 2016-2017 influenza season, nearly one in four adults who got an influenza vaccine were vaccinated in a pharmacy or retail setting.
• Designing and funding investigations into the factors associated with disparities in adult vaccination among racial and ethnic minority populations and projects designed to expand the evidence base for interventions to increase vaccination among adults with chronic medical conditions and underserved populations.
• Collaborating with numerous existing and new partners to expand flu vaccine coverage, with specific efforts to address racial and ethnic disparities for the 2021-2022 influenza season.  For example, CDC is working with the National Association for Community Health Centers to implement evidence-based strategies to increase adult vaccination coverage among underserved priority populations.  CDC has developed a large portfolio of new partnerships to promote COVID-19 and flu vaccination in high-risk populations, including communities of color, those living in rural settings, adults with chronic medical conditions (cardiovascular, diabetes, chronic lung conditions, etc.) and those in congregate settings (i.e., long-term care facilities, homeless shelters, and prisons).

HRSA’s Ryan White HIV/AIDS Program (RWHAP) works to improve health outcomes by preventing disease transmission or slowing disease progression for disproportionately impacted communities.  One way RWHAP accomplishes its mission is through the provision of medications that help patients reach HIV viral suppression.  People living with HIV who use medications designed to virally suppress the disease are less infectious, which reduces the risk of their transmitting HIV to others.

Within ASPR, the Biomedical Advanced Research and Development Authority (BARDA) uses an end-to-end strategy to prepare for the next influenza pandemic by supporting development, licensure, and manufacturing of better products to detect, treat, and prevent seasonal and pandemic influenza .  This strategy relies on the development of superior influenza diagnostics, treatments, and vaccines that can be rapidly manufactured.  BARDA continues to focus on developing capabilities to recognize potential pandemic influenza viruses in point-of-care settings, speeding influenza diagnosis to prompt early antiviral use and will also continue to support advanced development of new nucleotide sequencing technologies and prodromal or pre-symptomatic biomarkers for influenza.  The targets for this measure have been met or exceeded each year.  There are no missing or delayed data.  The data source is stable and quality assurance procedures are conducted.  The measure reflects that ASPR uses a comprehensive portfolio approach to develop and acquire a broad array of medical countermeasures for pandemic influenza.  The ASPR investments reflected through this data highlight support for advanced research and development, stockpiling, procurement, and capacity expansion.  Important context is that previous and ongoing investments in addressing the pandemic influenza threat proved invaluable to accelerate the COVID-19 response by jump-starting therapeutic and vaccine development using platform technologies for more rapid production and increased fill/finish capability.  By continuing to widen availability of enhanced influenza diagnostic tools, BARDA promotes effective, timely management and treatment of seasonal and pandemic influenza, and reduces its impact on health, communities, the Nation, and internationally.  Targets are set based on ongoing active projects specifically related to complex advanced research and development projects that are on the product development pathway to FDA licensure.  The products reported for this measure include those from ongoing clinical trials and manufacturing campaigns only related to Pandemic Influenza.

Influenza is a serious disease that causes significant morbidity and mortality, especially in the AI/AN population.  Influenza and resulting sequelae such as pneumonia are among the top 10 leading causes of death for AI/ANs, and influenza-related mortality is significantly higher among AI/AN populations compared with non-Hispanic Whites.  Influenza vaccination remains the best strategy for reducing influenza-related illness.  The IHS offers influenza vaccinations to eligible AI/ANs to support public health strategies for preventing influenza illnesses while also reducing influenza-related hospitalizations and deaths. 

Monitoring influenza vaccination uptake is critical to ensure that the AI/AN population is sufficiently protected from primary influenza infections as well as severe health outcomes such as pneumonia and influenza-related death.  The influenza vaccination rate measures the proportion of individuals receiving seasonal influenza vaccine among AI/AN adult patients.

Beginning in FY 2018, the IHS transitioned measure reporting from the Clinical Reporting System to the Integrated Data Collection System Data Mart and measure targets, including the influenza vaccination rate, were reset.  The IHS FY targets are set based on prior year performance and projected funding.  From FY 2018 through FY 2020, the IHS seasonal influenza vaccination rate for AI/AN adults 18 years of age and older improved.  During FY 2021, the influenza vaccination rate was 18.1% and increased to 20.0% in FY 2022.  These results did not meet the established FY targets.  IHS results are likely impacted by changes in healthcare-seeking behavior related to the COVID-19 pandemic and compounded by diversion of resources to stand up the COVID-19 immunization efforts.  Additionally, the IHS results are impacted by reliance on patients' self-report of vaccinations completed outside IHS, tribal, or urban Indian health care facilities, which may result in incomplete capture of true vaccination status among patients.

IHS reviews evidence-based recommendations to inform strategies to increase influenza vaccination coverage among AI/AN populations.  Each fiscal year the Influenza Vaccination Action Plan is updated with current recommendations and issued as the framework to increase vaccination coverage across the health care system.  The IHS continues to apply evidence-based approaches, including co-administration of COVID-19 and influenza vaccines and combining with other targeted vaccination efforts to maximize opportunities for influenza vaccination.  The IHS regularly incorporates strategies that improve influenza vaccination rates, such as use of standing orders that promote vaccine administration, proper documentation of vaccines given to aid tracking, and automated point-of-care reminders generated through electronic health record alerts to prompt vaccination when a patient is due.  In May 2021 the IHS implemented a pediatric immunization improvement initiative called “Safeguard our Future: Protect Tomorrow, Vaccinate Today”. This quality improvement project targeting changes in immunization workflow resulted in improved and sustained pediatric vaccination coverage rates. Additionally, in November 2022, the IHS initiated a call to action to increase vaccine coverage and protection against vaccine-preventable illness through a vaccine strategy called E3. The E3 approach focuses on offering Every patient, Every recommended vaccine, at Every encounter.  The IHS has also implemented data-driven interventions targeted to specific, highly susceptible patient populations to improve their specific influenza vaccination rates and related health outcomes.