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NEWS AND FEATURES

AAP-AMA Immunization Congress draws up solutions to vaccine financing, access issues

by Alyson Sulaski Wyckoff
Associate Editor

Three proposed solutions on how to fix the nation's broken vaccine financing and delivery system have been developed by a diverse group of leaders at the groundbreaking AAP-AMA Immunization Congress held Feb. 27-March 1 in Chicago.

More than 120 participants representing medical and public health societies, government, insurers and drug manufacturers discussed ways to reform what they called a "crisis" in the system.

Meeting organizers and participants were enthusiastic about the outcomes of the meeting.

"We've identified strategies that will bring benefits to pediatricians in a reasonably short time," said Jon R. Almquist, M.D., FAAP, past chair of AAP District VIII and chair of the AAP Task Force on Immunization.

Addressing pediatric, adolescent and adult immunization issues, the Congress marked a rare occasion when a group representing all stakeholders gathered to address common concerns. The underlying goals were to identify and prioritize key problems in the immunization delivery system and begin to find solutions, and provide to the entire United States access to all vaccines recommended by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP).

Relating stories from their practice experiences, pediatricians and others highlighted the woefully inadequate reimbursement system to cover vaccine-related costs, the daunting challenges of providing to all children an increasing number of new, expensive vaccines and the significant lag time from the point when a new vaccine is recommended to when insurance plans pay for it.

"The system is broken, and we're in real trouble," said Michael Severson, M.D., FAAP, chair of AAP District IV.

Noting that while vaccines and vaccination have been among the greatest success stories in public health, the attendees said the current delivery system threatens to greatly reduce or even eliminate the private provider role in vaccine delivery, fragment the medical home and place increased stress on the public sector - even at a time when children are protected from a record number of vaccine-preventable diseases.

"This crisis is not readily visible," said Walt A. Orenstein, M.D., FAAP, associate director of the Emory Vaccine Center and director of the Emory Program for Vaccine Policy and Development. "There is no resurgence of vaccine-preventable diseases due to failure to vaccinate. Our goal is to prevent tragedies, not deal with them later."

Dr. Orenstein, former director of the National Immunization Program at the Centers for Disease Control and Prevention (CDC) summarized the group's solutions, as follows:

• Fix vaccine administration fees.
  Collect data on the actual costs of delivering vaccines in private practice settings, obtain support from the Centers for Medicare & Medicaid Services and others, and use that data to educate insurers and Medicaid on appropriate reimbursement.
• Work with vaccine manufacturers to obtain more favorable terms for initial inventories for new vaccines, which require larger upfront investments.
  This is more important for smaller practices, and the terms should be built into the pricing.
• Work with Federally Qualified Health Centers to delegate authority to public health clinics to serve underinsured children through the Vaccines for Children program.
  An effort to decrease pressure on the need for Section 317 (vaccine purchase fund) appropriations, this solution offers a safety net for referring underinsured children to public clinics for vaccines if other solutions to underinsurance are not found.

Some of the areas of consensus established by the participants included:

• Support universal access to all vaccines recommended by ACIP. Maintain the important private-public sector collaboration in vaccine delivery.
• Ensure national solutions, to avoid reservoirs of disease.
• Emphasize nonlegislative remedies to more rapidly address the problems, realizing that legislative solutions may become necessary.

To support the general solutions, nine specific recommendations also were developed. The AAP Task Force on Immunization is expected to follow up on the recommendations and assign responsibilities for the various projects identified. For an executive summary and white papers from the Congress, visit www.aap.org/advocacy/ImmFinPosPaper.pdf. Look to future issues of AAP News for updates.

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