Financing Vaccines in the 21st Century Assuring Access and Availability (2004) / Chapter Skim
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1 Introduction
1 Introduction
Pages 21-38
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asked the IOM to examine what is known about current vaccine finance arrangements and to identify strategies that could resolve the basic tensions and uncertainties that permeate existing vaccine purchasing systems in the public and private health care sectors. The Committee on the Evaluation of Vaccine Purchase Financing in the United States was formed to conduct this study.
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(5) Will vaccine products under consideration for licensing have a significant effect on future vaccine purchase strategies in public and private health plans?
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has received a significant portion of the recommended vaciThe 4:3:~:3:3 series, which constituted the universal recommended schedule in 2001, comprises 4 doses of diphtheria-tetanus-acellular pertussis vaccine, 3 doses of poliovirus vaccine, 1 dose of measles-containing vaccine, 3 doses of hepatitis B vaccine, and 3 doses of haemophilus influenzue type b vaccine. Varicella and pneumococcal conjugate vaccines are measured separately.
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First, the public health goal of 80 percent immunization of 2-year-old children with recommended vaccines has never been achieved. While outbreaks of vaccine-preventable disease have decreased significantly, full immunization of the young, and especially vulnerable child populations, with all 2The reported percentages are as follows: 94 percent receive 3 of the 4 recommended diphtheria-pertussis-tetanus (DPT)
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Second, broad disparities remain in state and local immunization rates for young children. There is substantial variation in immunization rates among states.
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But the achievement of immunization goals requires more than the discovery of a vaccine. A complex web of financial and institutional arrangements representing a unique public and private partnership is involved in moving a vaccine from the product discovery phase, through the production and development cycle, to licensing and recommendation for general or specialized use, and into the health care delivery system.
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Some vaccines produce significant benefits in early childhood; others provide protection during adolescence or adult life. The benefits of some vaccines are associated with their impact on mortality due to life-threatening diseases (such as measles)
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,C hepatitis A, and pneumococcal conjugate; (3) Multiple cohorts, dynamic model, using vaccine efficacy: varicella (Lieu et al., 1994a)
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By 2000, however, the prices of newer and improved vaccines for the same diseases had risen significantly. Furthermore, recent additions to the immunization schedule such as varicella and pneumococcal conjugate have been priced at substantially higher levels (Table 1-4~.
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$11.75 to $19.65 $12.00 DTaP-Hep B-IPV GlaxoSmithKline Pediarix $32.75 $60.06 DTaP-Hibb,c Aventis Pateur TriHIBit(~) $23.40 $38.21 Aventis Pasteur IPOL(~)
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, for example, range between $50 and $500 per dose. The higher prices of new vaccine products have a significant impact on federal budgets designed for the purchase of vaccines for disadvantaged populations.
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SOURCE: Davis et al., 2002. CDC, which purchases over half the volume of vaccines distributed in the United States.
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The total cost of purchasing vaccines for the recommended childhood schedule for children up to age 2 is currently about $400 (this figure includes only the vaccine product cost and does not cover the vaccine administration fee commonly charged by clinicians)
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Over time, the interactions between the goals of assurance and availability have become increasingly complex. The effort to integrate the immunization process directly into the delivery of routine health care services has fostered the development of myriad programs and safety net services designed to assure that all children have access to recommended 6This report follows the CDC National Immunization Program's definition of underinsured, which includes only those persons who have medical insurance coverage that excludes coverage for immunizations.
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Initial warning signs of increased tensions have already appeared in the form of delays in reimbursement to health care providers for vaccine costs, shortages in the vaccine supply system, dwindling numbers of vaccine manufacturers in the United States, gaps in the coverage of recommended vaccines by private health plans, and hesitation to recommend newly licensed vaccines because of concerns about higher costs. The fact that at least six of the routine childhood vaccines, as well as the adult influenza vaccine, are produced by foreign manufacturers has been raised as an additional concern.
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In addition, tensions have emerged in both assuring access to vaccines and sustaining the availability of a reliable supply of vaccines in the health care system during periods of fiscal restraint and higher prices for new vaccine products. Health officials have expressed concern that higher costs will lead to reduced health plan benefits for immunization and that low administration fees and the burden associated with checking the status of vaccine benefits are contributing to missed opportunities and private-sector referrals to public health clinics.
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Chapter 3 describes aspects of vaccine finance related to public and private insurance coverage, including private health care plans and such public plans as Medicare, Medicaid, VFC, and SCHIP. Chapter 4 focuses on the health care delivery system, examining arrangements for clinician reimbursement and factors that influence access to vaccines in routine health care settings.
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