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Initial Guidance for an Update of the National Vaccine Plan: A Letter Report to the National Vaccine Program Office
Features of the 1994 National Vaccine Plan
The plan was to “establish priorities in research and the development, testing, licensing, production, procurement, distribution, and effective use of vaccines, describe an optimal use of resources to carry out such priorities, and describe how each of the various departments and agencies will carry out their functions in consultation and coordination with the [National Vaccine] Program and in conformity with such priorities.” The 1994 plan’s aims included reducing “the incidence of infectious diseases through vaccine development and immunization” and integrating all U.S. efforts on vaccine development and immunization, whether their focus was domestic or global (NVPO, 1994: p. 13). The plan had four goals3: (1) to develop new and improved vaccines; (2) to ensure the optimal safety and effectiveness of vaccines and immunization; (3) to better educate the public and members of the health professions on the benefits and risks of immunizations; and (4) to achieve better use of existing vaccines to prevent disease, disability, and death. The plan also offered 26 objectives along with more than 70 strategies for achieving those objectives. In addition, 14 anticipated outcomes were offered as a basis for judging the success of the plan (see Appendix D).
The Committee’s Approach to Reviewing the Plan
The committee reviewed the goals, objectives, strategies, and anticipated outcomes presented in the plan. In the interest of time and in recognition of the statement of task and the plan’s acknowledged limitations (notably, the lack of measurable objectives), the committee did not undertake a point-by-point evaluation of what the plan has or has not achieved. Instead, in the first section of this letter report, the committee examines what has changed in the broader social, policy, and economic context of vaccine development and immunization, and highlights several areas where noteworthy progress has been made, particularly by federal agencies. The committee acknowledges that progress in developing and delivering vaccines has benefited from essential contributions by other stakeholders, including researchers, manufacturers, state and local public health agencies, and health care providers. In the second section of this letter report, the committee uses what it learned from reviewing the 1994 plan and the process of preparing it to distill key elements. Based on these elements, the committee offers guidance to NVPO and its partners on developing the update to the national vaccine plan.
CHANGES SINCE 1994
Important changes in the world, in American society, and in the delivery and financing of health care have occurred or have grown in prominence since 1994. For example, several key changes have been made in how the U.S. health care delivery system is organized. More elderly and underserved populations receive health care, including immunizations, through private health care delivery systems under the auspices of Medicaid and Medicare managed care programs.4 With significant government-
NVPO intends to retain these goals to structure the update to the plan.
According to CMS, two-thirds of the Medicaid population is enrolled in managed care organizations (more than 90 percent in many states). There are now over 500 separate managed care plans nationally providing health services to more than 40 million enrollees (CMS, 2006).