CQ HealthBeat – Kids Vaccine Program Sees Funding Bump in Era of Tight Budgets
By Kerry Young, CQ HealthBeat Associate Editor
In a time of austere spending on public health, the Centers for Disease Control and Prevention is forecasting a hefty budget increase in one area: a program to provide free vaccines to children.
Expenses for the Vaccines for Children program will rise by $514 million in fiscal 2015 to $4.08 billion, an increase of about 14 percent, according to a detailed analysis of the CDC’s annual budget request, known as a congressional justification. The spending bump is needed due to an expected increase in the price of routine vaccines for children and anticipated costs associated with maintaining the effectiveness of these shots in storage, the CDC said.
“These resources will help support a comprehensive immunization program, based on strong science — from establishing and implementing vaccine policy to monitoring the effectiveness, impact, coverage, and safety of routinely recommended vaccines,” the agency said.
The Government Accountability Office in 2012 reported finding that medicines purchased for the effort often were not handled well as they moved through the supply stream. CDC buys vaccines at a discount and supplies them to state and local health agencies, which then distribute the medicines to doctors’ offices and public health clinics.
The GAO found that vaccines stored by more than three-quarters of the 45 selected providers were exposed to inappropriate temperatures for at least five hours straight. It also found cases where expired vaccines were left mixed with current supply, increasing the risk that a child would get an ineffective shot.
CDC highlights this GAO report and its findings on the main web page for the Vaccines for Children program.
“CDC and our partners are working with a sense of urgency to address these issues,” the agency says on the web page, by incorporating the report findings and recommendations in a plan to strengthen VFC. It calls the program “a vital component in the United States’ successful efforts to protect US residents from vaccine preventable diseases.”
About 40 million children received a total of 82 million shots through Vaccines for Children in 2010, according to the GAO. The vaccines cover 16 conditions; diphtheria, haemophilus influenzae type b(Hib), hepatitis A and B, human papillomavirus (HPV), influenza, measles, meningococcal disease, mumps, pertussis (whooping cough), pneumococcal disease, polio, rotavirus, rubella (German measles), tetanus (lockjaw) and varicella (chickenpox), according to the CDC’s web site.
The Vaccines for Children program was designed to make sure that children living in or near poverty, or whose families lack adequate insurance coverage, have access to routine shots. Congress created the program through the 1993 Omnibus Budget Reconciliation Act (PL 103-66) in response to a measles epidemic between 1989 and 1991. The outbreak caused tens of thousands of cases of this largely preventable disease and led to hundreds of deaths.
CDC says it later determined that more than half of the children who had measles had not been immunized, even though many of them had seen a doctor. Vaccines for Children is intended to make sure that children don’t miss out on vaccines due to parents’ inability to pay for them.
The program is funded as a Medicaid benefit, but then is administered by CDC. That puts the program on the mandatory side of federal budget and gives the administration more flexibility to address what it deems pressing needs.
Most of the CDC’s operating expenses are set through the annual appropriations process. There have been tight budget caps on this discretionary spending in recent years, and fiscal 2015 will prove no exception. The cap on discretionary spending will lift only slightly to $1.014 trillion from the current level of $1.012 trillion. The agency has said that it expects its total obligations for fiscal 2015 to be $6.28 billion, less than the $6.67 billion provided for the current budget year.
Lawmakers deliberately designed the Vaccines for Children program to run as a mandatory benefit to spare it from year-to-year uncertainties in the appropriations process, said Georges C. Benjamin, the executive director of the American Public Health Association in an interview.
“It was a conscious thought” that reflected the then strong bipartisan support for the vaccines initiative, he said. “They treated it like they treat medical care, and not like they treat public health.”
Benjamin said that he was pleased to see an anticipated increase for Vaccines for Children, as the extra funds will address growing demand for these products. But, this is an example that makes clear the limits that the CDC, the nation’s premier public health agency, faces in the current tough competition for discretionary funds, he noted. “That vast majority of the public health system falls into that side of the ledger,” he said, noting that the CDC and other public health agencies have mandates that they must fulfill even in tough budget years. “It’s not really discretionary, but people act as if it were.”
Benjamin said he is looking for Congress to take steps in the future to ease the limits that it has placed on discretionary spending. Congress built the current sequester, largely affecting discretionary spending, into the 2011 budget accord (PL 112-25), as kind of budgetary doomsday device, intending to force lawmakers to reach agreement on a sweeping fiscal deal.
That never happened, but Congress has acted several times already to give federal agencies some relief from the sequester. A December budget deal (PL 113-67) worked out by the leaders of Budget committees, Sen. Patty Murray, D-Wash., and Rep. Paul D. Ryan, R-Wis., eased the sequester’s bite somewhat. Left unchanged, previous budget deals would have kept the federal government’s annual routine operating expenses in the range of roughly $990 billion to $1 trillion for fiscal years 2014 and 2015. Instead, the annual caps on discretionary spending were raised to about the $1.01 trillion level for both years though the Ryan-Murray deal. There may be further such agreements after the November election, when lawmakers can move away from their most partisan positions, Benjamin said.
“I am hoping that they will begin talking to each other more frequently and making good data-driven decisions in terms of protecting the health of the public,” he said.
In the meanwhile, the CDC still intends to respond in fiscal 2015 to pressing public health issues with new initiatives, although they seem far more limited than the $514 million expansion likely to be allowed for Vaccines for Children.
In its budget justification, CDC outlines three major new initiatives: Increasing spending by $45 million to expand global health security activities, directing an additional $30 million to the fight against antibiotic resistance and adding $15.6 million to combat prescription drug overdoses.
The CDC also would like to direct a combined $141 million in spending increases to the following:
•$27.9 million increase for Surveillance, Epidemiology and Public Health Informatics.
•$15 million increase for Public Health Workforce Capacity
•$14 million increase for the National Healthcare Safety Network
•$14 million increase for the World Trade Center Health Program
•$12.2 million increase for the National Violent Drug Reporting System
•$10 million increase for Polio Eradication
•$10 million increase for Cancer Screening Demonstration Project
•$10 million for Gun Violence Prevention Research
•$10 million for Food Safety efforts
•$7.4 million for Domestic HIV/AIDS prevention and research
•$5.6 million for Rape Prevention and Education
•$5.4 million for Energy Employees Occupational Illness Compensation program