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Priorities for the National Vaccine Plan
Appendix A
Draft Strategic National Vaccine Plan
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Draft Strategic National Vaccine Plan
November 26, 2008
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Draft Strategic National Vaccine Plan
Table of Contents
Page
Preface: Letter from the Assistant Secretary for Health
4
Acronyms and Abbreviations
5
Executive Summary
8
Introduction
15
Purpose, Perspective, and Scope
17
Approach to Developing the Plan
18
Framework
20
National Vaccine Plan Structure
21
Monitoring and Evaluation
22
Goal 1: Develop new and improved vaccines
25
Goal 2: Enhance the safety of vaccines and vaccination practices
32
Goal 3: Support informed vaccine decision-making by the public, providers, and policy-makers
39
Goal 4: Ensure a stable supply of recommended vaccines, and achieve better use of existing vaccines to prevent disease, disability, and death in the United States.
47
Goal 5: Increase global prevention of death and disease through safe and effective vaccination
56
Appendix 1: Anticipated outcomes from the 1994 National Vaccine Plan and the extent to which each has been achieved at the time the draft strategic National Vaccine Plan was drafted in 2008
63
Appendix 2: IOM committee recommendations from the June 11,2008 letter report “Initial Guidance for an Update of the National Vaccine Plan: A Letter Report to the National Vaccine Program Office” and National Vaccine Program Office responses
67
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Appendix 3: Key Stakeholders in the United States National Vaccine System
70
Appendix 4: Roles and Responsibilities of Department of Health and Human Services Agencies and Offices, and other federal Departments in the draft strategic National Vaccine Plan
73
Appendix 5: HHS Agency and Other Federal Department Strategic Plans relevant to the draft strategic National Vaccine Plan
84
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Preface: Letter from the Assistant Secretary for Health
Given the importance of vaccines and immunizations in the prevention of an expanding number of infectious diseases, it is important that we – as a Department and as a Nation --clearly articulate our vision for the vaccine and immunization enterprise. In my role as the Assistant Secretary for Health and the Director of the National Vaccine Program, I have directed and monitored the efforts to update the 1994 National Vaccine Plan
The accompanying draft strategic National Vaccine Plan reflects current priorities and potential future directions for the next decade. This draft Plan offers a clear signal about our goals for vaccines and immunizations to our domestic and international partners in the United States vaccine and immunization enterprise and abroad, both public and private in the United States and abroad. It is a strong beginning, but requires extensive consultation with and input from many partners, including the public. This input will also enable us to develop an implementation plan with discrete activities and measurable milestones. With release of this draft Plan, consultations with stakeholders will begin, led by the National Vaccine Program Office and the National Vaccine Advisory Committee. We all look forward to the final products of these efforts in late 2009.
This draft strategic National Vaccine Plan responds to the mandate of Congress contained in P.L. 99-660, in which the vision of the National Vaccine Program was first outlined. The first National Vaccine Plan had fourteen expected outcomes, most of which have been achieved at least in part. However, the world of vaccines has changed dramatically since 1994, with more diseases for which vaccines could be available, multiple new research tools, many available new vaccines, heightened interest in vaccine safety, new communications tools, and many more people for whom vaccines are routinely recommended.
This draft Plan describes proposed strategies for ways in which the United States can promote immunization to protect the health of all people. Subsequent work with our many partners will enhance and improve this draft, so the final plan can implement strategies to assure all people can benefit from the prevention of infectious diseases.
Joxel Garcia, M.D., M.B.A.
Assistant Secretary for Health And Director, National Vaccine Program
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Acronyms and Abbreviations
AAFP American Academy of Family Physicians
AAP American Academy of Pediatrics
ACIP Advisory Committee on Immunization Practices
AEFI adverse events following immunization
ASPA Assistant Secretary for Public Affairs (Department of Health and Human Services)
ASPR Assistant Secretary for Preparedness and Response (Department of Health and Human Services)
BARDA Biomedical Advanced Research and Development Authority
BLA Biologics License Application
CDC Centers for Disease Control and Prevention
CBER Center for Biologics Evaluation and Research
CMS Centers for Medicare and Medicaid Services
DARPA Defense Advanced Research Projects Agency
DoD Department of Defense
DHS Department of Homeland Security
DoJ Department of Justice
DTP diphtheria, tetanus toxoids, and pertussis vaccine
DTaP diphtheria, tetanus toxoids, and acellular pertussis vaccine
DTRA Defense Threat Reduction Agency
DVIC Division of Vaccine Injury Compensation
FDA Food and Drug Administration
FY fiscal year
GAVI Global Alliance for Vaccines and Immunization, now formally known as the GAVI Alliance
GMP Good Manufacturing Practices
HBV Hepatitis B virus
HEDIS Healthcare Effectiveness Data and Information Set
HHS U.S. Department of Health and Human Services
Hib Haemophilus influenzae type b
HIV human immunodeficiency virus
HP2010 Healthy People 2010
HRSA Health Resources and Services Administration
IDSA Infectious Diseases Society of America
IHS Indian Health Service
IOM Institute of Medicine
IPV inactivated polio vaccine
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MCOs managed care organizations
MMR measles, mumps, and rubella virus vaccine (combined)
NCIRD National Center for Immunization and Respiratory Diseases
NCPDCID National Center for Preparedness, Detection, and Control of Infectious Diseases
NGO Non-governmental organization
NIAID National Institute of Allergy and Infectious Diseases
NIH National Institutes of Health
NVAC National Vaccine Advisory Committee
NVP National Vaccine Program
NVPO National Vaccine Program Office
OD Office of the Director
OMHHD Office of Minority Health and Health Disparities
OPDIV Operating Division of the Department of Health and Human Services (e.g., CDC)
OPV oral polio vaccine
PHEMCE Public Health Emergency Medical Countermeasures Enterprise
PHS Public Health Service
P.L. public law
STAFFDIV Staff Division of the Department of Health and Human Services (e.g., Office of Public Health and Science, of which NVPO is included)
TB tuberculosis
Td tetanus and diphtheria toxoids (adult formulation)
Tdap tetanus and diphtheria toxoids, and acellular pertussis vaccine (adult formulation)
UNICEF United Nations International Children’s Emergency Fund (now United Nation’s Children’s Fund)
USAID U.S. Agency for International Development
USAMRIID U.S. Army Medical Research Institute of Infectious Diseases
VA Department of Veterans Affairs
VAERS Vaccine Adverse Event Reporting System
VFC Vaccines for Children program
VHA Veterans Health Administration
VICP National Vaccine Injury Compensation Program
VPD vaccine-preventable disease
VRC Vaccine Research Center
VSD Vaccine Safety Datalink project
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WHO World Health Organization
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Executive Summary
The National Vaccine Program was established in 1986 to achieve optimal prevention of infectious diseases through immunization and optimal prevention of adverse reactions to vaccines. The purpose of the National Vaccine Plan is to promote achievement of the National Vaccine Program mission by providing strategic direction and promoting coordinated action by vaccine and immunization enterprise stakeholders.
Federal involvement in civilian and military vaccination programs is longstanding, including in research and development, regulation, vaccine delivery and the evaluation of the impacts of immunizations. This draft strategic National Vaccine Plan builds on the many achievements of the vaccine and immunization enterprise prior to and since the establishment of the National Vaccine Program in 1986 and the completion of the first National Vaccine Plan in 1994. New vaccine preventable disease targets have been identified and new vaccines have been developed and licensed; many of these new vaccines are now recommended for children, adolescents and adults. These new vaccines have expanded the number of infections that can be prevented, and more effectively and safely prevent some diseases for which earlier generation vaccines already existed. In addition, federal immunization financing programs have reduced or eliminated many financial barriers to immunizations, particularly for children. The number of infections that are preventable by vaccination has decreased significantly while vaccination coverage in the United States has increased, and coverage for many vaccines has reached record levels. More robust systems have been developed to identify adverse events following immunization and to assess potential associations of those events with vaccination. Globally, the United States has worked with multilateral and bilateral partners and non-governmental organizations in contributing to improvements in child health status and the prevention of hundreds of thousands of child deaths each year through improved vaccine coverage and introduction of new vaccines. Of the fourteen anticipated outcomes included in the 1994 National Vaccine Plan, most were substantially or fully realized (see Appendix 1).
Despite these successes, however, many of the challenges that stimulated establishment of the National Vaccine Program and the development of the 1994 National Vaccine Plan remain relevant today. Vaccine shortages have frequently been experienced for many routinely recommended vaccines. Despite improved vaccination coverage among children, the occurrence of several recent vaccine preventable disease outbreaks serves as a reminder that these diseases still occur. Among older adults both vaccination coverage and the effectiveness of some routinely recommended vaccines remain sub-optimal. As the number of vaccines has increased and vaccine preventable diseases have declined, vaccine safety concerns are expressed more prominently today and may be more widely shared. Enhancing the current vaccine safety system is important to keep pace with several factors influencing it: an increasing number of vaccines and vaccine combinations, expanding target populations, and a better understanding of human biology, especially the human immune system. As the cost of vaccination has increased, financial barriers to vaccination have emerged for health departments, healthcare providers, and the public. Significant scientific challenges remain in the development of
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safe and effective vaccines against existing global health threats, such as HIV, TB and malaria. Vaccines that have been developed and are in use in industrialized countries have the potential to make major contributions to health in developing countries, but are being underused. Additionally, emerging and pandemic infections and bioterrorist threats pose new challenges for vaccine development and regulation, manufacturing, vaccine delivery and access in the US and abroad.
In the context of the many challenges and opportunities that exist, updating the 1994 National Vaccine Plan is an opportunity to provide a strategic focus for the nation’s efforts to improve disease prevention and enhance vaccine safety. This draft strategic National Vaccine Plan is primarily the result of deliberation, analysis, and input from multiple Federal agencies under the coordination of the National Vaccine Program Office (NVPO). A committee empanelled by the National Academy of Sciences’ Institute of Medicine (IOM) reviewed the 1994 National Vaccine Plan and provided guidance on the development of the updated Plan (see Appendix 2). Because successfully preventing infectious diseases and enhancing vaccine safety are outcomes of a complex process, identifying objectives and strategies that lead to and sustain these outcomes is facilitated by understanding the many interconnected determinants of these outcomes. A framework that identifies components of the vaccine and immunization enterprise and illustrates their interrelationships is shown in Figure 1. While a simplification of a complex system, this framework provides an overview of key processes from beginning to end (critical components are shown as rectangular boxes and intermediate and long term outcomes as rounded boxes). The intermediate and long term inputs and outcomes of the vaccine and immunization enterprise include the Recognition of public health priorities, Vaccination (adult, adolescent and childhood), High vaccination rates, Population health protection against infectious disease in the U.S. and globally, and Reduced morbidity and mortality from infectious diseases in the U.S. and globally. The critical components of the vaccine and immunization enterprise that contribute to achieving the desired outcomes include Translational research for diffusion of innovation, Disease surveillance, Vaccine research, Vaccine development, Vaccine licensure, Vaccine manufacture, Vaccine sales/purchase, Vaccine distribution, Communications and education strategies, Attitudes about vaccination, Develop vaccine recommendations, Access/payment for vaccination reimbursement, Adverse event monitoring, Vaccine effectiveness, and Vaccine coverage surveillance.
Figure 1. Overview of the vaccine and immunization enterprise
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The goals, objectives, and strategies included in this plan were drafted by Federal departments and agencies for which vaccines and immunization are a significant part of their mission and provide a comprehensive approach to reach these outcomes through coordinated efforts of Federal, State, local, multinational and non-governmental stakeholders. Recognizing that success is facilitated by careful planning that includes defining specific activities, milestones and measurable outcomes, an implementation plan will be developed based on this draft plan. With a ten-year horizon, the framework balances a strategic vision, which requires development and implementation of new initiatives, with the recognition that changing circumstances and new opportunities and challenges will occur over the next decade. The ten-year horizon also allows incorporation of the HealthyPeople 2020 objectives once those are established. Annual monitoring of progress and a mid-course review will promote both accountability and flexibility.
The Plan is built around the achievement of five broad goals:
Goal 1: Develop new and improved vaccines
Goal 2: Enhance the safety of vaccines and vaccination practices
Goal 3: Support informed vaccine decision-making by the public, providers, and policy-makers
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Office of the Assistant Secretary for Public Affairs
Coordinates public information and communications, including all aspects of vaccination, vaccine supply, vaccine preventable diseases and vaccine safety issues
Office of Intergovernmental Affairs
Advises and coordinates outreach and communications to state, local and tribal officials and national intergovernmental organizations
Office of the Surgeon General
Oversees the operations of the 6,200 active duty officers of the Commissioned Corps of the U.S. Public Health Service
Deploys commissioned officers to meet urgent public health needs and provide public health and medical services in response to natural and man-made disasters.
Provides trusted and credible health and medical information to the public, improving health and reducing the risk of illness and injury
Assigns officers to HHS and non-HHS Federal agencies to provide clinical, technical, regulatory, disease surveillance, program management and research services.
Coordinates nearly 800 local units of the Civilian Volunteer Medical Reserve Corps, representing over 170,000 health volunteers.
Coordinates the USPHS Inactive Reserve Corps comprising over 1,000 health professionals in 11 professional categories who are Federalized to respond to disasters or urgent public health need.
Office of the General Counsel
Advises on legal issues and authorities related to key vaccination activities
Office of Global Health Affairs
Coordinates interactions with health authorities in other governments and international organizations in
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coordination with the Department of State
Office of the National Coordinator for Health Information Technology
Coordinates the Department of Health and Human Services’ (HHS) health information technology policies and programs internally and with other relevant executive branch agencies
Develops, maintains, and directs the implementation of HHS’ strategic plan to guide the nationwide implementation of interoperable health information technology in both the public and private health care sectors, to the extent permitted by law, including immunization information systems
Provides comments and advice at the request of OMB regarding specific Federal health information technology programs.
National Vaccine Program Office (NVPO)
Coordinates communication between vaccine manufacturers and HHS agencies
Coordinates National Vaccine Plan development and periodic review
Coordinates vaccine safety planning and public engagement
Coordinates and provides direction on vaccine research and development
Coordinates vaccine supply activities
Coordinates governmental and non-governmental vaccine activities
Agency for Healthcare Research and Quality
Communicates with and supports federal, state, and local public health partners on vaccination and healthcare delivery plans
Centers for Disease Control and Prevention (CDC)
Conducts and supports clinical and laboratory vaccine-preventable disease and microorganism surveillance, as well for diseases and microorganisms that may become vaccine preventable
Coordinates vaccine-preventable disease response
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activities with state, local and tribal public health agencies
Investigates epidemiology, environmental contributions to, and clinical characteristics, of vaccine-preventable disease
Leads in federal vaccination program implementation and supports state and health care provider immunization through vaccine purchase, distribution, guidance, evaluation, and quality control
Distributes public sector vaccines
Co-leads with FDA in monitoring and investigating vaccine adverse events
Assesses vaccine effectiveness in population-based studies
Makes recommendations on diagnosis, management, and prevention of vaccine-preventable disease illness
Conducts and supports basic and applied research on vaccine-preventable diseases
Leads federal activities for surveillance, detection, and response to pandemic influenza
Provides training and reagents for diagnosis of vaccine-preventable diseases
Conducts and supports research and development of diagnostic test and immunologic assays for vaccine-preventable diseases
Conducts human health risk assessment of new and emerging vaccine-preventable diseases in the US and globally
Conducts laboratory and animal studies of emerging vaccine-preventable diseases to identify markers for virulence and transmission among humans
Communicates with state and local health departments and other public health partners
Communicates information on vaccine-preventable disease health impacts and vaccination in collaboration with ASPA and other partners
Maintains close communication with vaccine manufacturers
Provides reference strains for influenza vaccine manufacturing
Works with WHO and other international organizations to promote global health through vaccination
Provides scientific leadership and support to global laboratory networks for vaccine preventable diseases, technical support to eradication and elimination
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efforts and accelerating use of new and underutilized vaccines
Centers for Medicare and Medicaid (CMS)
Provides streamlined payment mechanisms and works with prescription drug plans, Medicare managed care plans, and Medicare providers, as necessary, to ensure ready access to vaccines for Medicare’s population
Communicates specific vaccine-preventable disease guidance to the nation’s hospitals, home health agencies, skilled nursing facilities and other health care providers, suppliers and practitioners that participate in Medicare and Medicaid
Communicates vaccine-preventable disease related information through existing outreach networks to Medicare and Medicaid beneficiary populations
Supports tracking and surveillance of Medicare and Medicaid patients, including high-risk and vulnerable patients, who have received vaccines, including review of Medicare and Medicaid claims and quality data
Food and Drug Administration (FDA)
Performs research to 1) facilitate vaccine development and evaluation, including through innovation in regulatory pathways, and 2) enhance manufacturing and product quality (including assays, biomarkers and models for product safety, quality and efficacy, and methods for statistical and epidemiological analysis)
Regulates vaccines’ manufacturing processes and promotes enhancement of manufacturing quality and problem prevention
Prepares reference strains, assays, standards, and reagents appropriate for vaccine manufacturing
Evaluates and licenses vaccines
Monitors vaccine quality, releases vaccine lots for distribution, performs testing of vaccine quality and potency
Facilitates the development, evaluation and clearance or approval of diagnostic tests and devices
Reviews vaccine supply issues
Evaluates and issues Emergency Use Authorizations when appropriate
With CDC, monitors vaccine adverse events
Maintains close communication with vaccine manufacturers
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Makes necessary changes in prescribing and patient information, including dosing, target populations, and other direction for use, for vaccines based on research and adverse events
Monitors to protect against the distribution of counterfeit vaccines
Designated as a WHO Collaborating Center for Biological Standardization, which encompasses responsibilities of setting and providing standards needed to assure products are high quality, safe, and available, and supporting efforts to harmonize product development and regulation.
National Institutes of Health (NIH)
Studies the evolution and emergence of microorganisms, including the identification of factors that affect their host-range and virulence
Determines the molecular basis of virulence in humans and animals
Supports laboratory-based surveillance studies of the distribution of microorganisms that are, or may be, vaccine-preventable
Develops sensitive, specific, and rapid diagnostic tests for vaccine-preventable diseases
Develops and clinically evaluates novel vaccines and vaccination strategies (e.g., adjuvants, delivery systems)
Evaluates the immune response to infection and vaccination
Supports basic research, with the goal of identifying new therapeutic targets
Evaluates the molecular and/or environmental factors that influence the transmission of viruses, bacteria and other organisms, including drug-resistant strains
Maintains close communication with vaccine manufacturers
Prepares reference strains appropriate for vaccine manufacturing
Health Resources and Services Administration (HRSA)
Provides national leadership, program resources and services needed to improve access to culturally, competent (including linguistic and health literate), quality health care.
As the Nation’s access agency, focuses on uninsured, underserved, and special needs populations in its
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goals and program activities (including vaccine preventable diseases and vaccine administration).
Communicates with and provides technical assistance and training to support vaccine-preventable disease control activities of state primary care associations, health centers, and other community-based providers
Operates the National Vaccine Injury Compensation Program to ensure an adequate supply of vaccines, stabilize vaccine costs, establish and maintain an accessible and efficient forum for individuals found to be injured by certain vaccines to receive compensation.
Indian Health Service
Communicates with and supports state, local, and tribal vaccination and vaccine-preventable disease response activities at HHS, tribal, and urban Indian sites serving American Indian and Alaska Native populations
Substance Abuse & Mental Health Services Administration
Brings effective alcohol and drug treatment to every community.
Provides national leadership to expand the availability of effective treatment and recovery services for alcohol and drug problems; to improve access, reduce barriers and promote high-quality effective treatment and medical care services (including vaccination services) for people with alcohol and drug problems, abuse, or addiction as well as for their families and communities.
Department of Agriculture
Manages Women, Infant, and Children’s program for supplemental nutrition that also provides vaccination services.
Performs research on animal vaccines to prevent disease
Department of Defense
Assistant Secretary of
Serves as the principal civilian advisor to the Deputy
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Defense for Health Affairs
Secretary of Defense for health service support for pandemic influenza preparedness and response
Responsible for overall leadership of the Military Health System
Serves as the principal advisor to the Secretary of Defense for all Department of Defense (DoD) health policies and programs
Oversees all DoD health resources
Defense Advanced Research Projects Agency
Maintains the technological superiority of the U.S. military and prevent technological surprise from harming our national security.
Funds researchers in industry, universities, government laboratories and elsewhere to conduct high-risk, high-reward research and development projects that will benefit U.S. national security.
Develops technologies to accelerate the development and production of vaccines and other medical therapeutics from 12 years to only 12 weeks
Defense Threat Reduction Agency
Provides capabilities to reduce, eliminate, and counter the threat of weapons of mass destruction (chemical, biological, radiological, nuclear and high explosives), and mitigate its effects.
Analyzes weapons of mass destruction threats, develops requirements forecasts and integrates the results into DTRA’s future resource planning
Develops, provides, and maintains security, counterintelligence, and force protection products and services in support of the agency’s global missions.
The Military Vaccine (Milvax) Agency
Synchronize information among the Military Services and DoD staff elements
Deliver education for healthcare workers and the public (e.g., Immunization University, www.vaccines.mil (877) GET-VACC, Vaccines@amedd.army.mil
Promote quality in immunization understanding and delivery
Coordinate and assess U.S. military immunization programs worldwide
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Assist senior DoD leaders with policy development, especially related to biodefense and pandemic issues
Safeguard shipping and handling of temperature-sensitive medical products
Enhance scientific understanding of the benefits and risks of vaccines
Foster mutually beneficial relationships between DoD, other government agencies, and professional associations related to immunizations
Integrate electronic immunization tracking efforts of DoD and the Services
Conducts basic and applied research on biological threats resulting in medical solutions to protect the warfighter.
Plays a key role as the only laboratory in the Department of Defense (DoD) equipped to safely study highly hazardous infectious agents requiring maximum containment at biosafety level (BSL)-4.
United States Army Medical Institute for Infectious Diseases
Ensures that research is conducted in a safe and secure environment.
Delivers competitive products to the advanced developer on schedule with the best value and quality.
Participates in the Global Alliance for Vaccines and Immunization and introduces new and under-utilized vaccines into developing countries.
Provides technical and commodity assistance to more than 100 countries in support of routine child immunization programs, working closely with host-country Ministry’s of Health, Non-governmental Organizations, International Organizations such as WHO and UNICEF, foundations and other international partners
Maintains a vaccine development program targeting malaria and HIV/AIDS in developing countries in coordination with DoD, HHS, and non-federal partners.
Provides technical assistance and funding for the Global Polio Eradication Initiative
Supports global goals to eliminate and control other
United States Agency for International Development
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vaccine preventable diseases such as measles and neonatal tetanus.
Raises awareness and helps generate greater resources, from both the public and private sectors, to help countries improve and sustain their capacity to deliver lifesaving vaccines and address diseases of international and domestic public health importance
Mounts a system-wide annual seasonal influenza campaign for VHA patients and health care providers
Actively monitors, on a national basis, receipt of influenza and pneumococcal vaccine among at risk VHA patients
Monitors adverse events to vaccinations as part of a national pharmacovigilance program
Supports health services research in the area of improving vaccine delivery within VHA healthcare settings
Educates, communicates with, and provides technical assistance to VHA providers to support vaccine-preventable disease control activities in all VA health care facilities
Participates in clinical trials to determine efficacy of new/improved vaccines
Monitors national influenza vaccination rates of employees working in VHA health care facilities
Developing an occupational health record system for employees to track vaccination status
Contributes support and provides expertise to national bodies focused on vaccine and immunization programs.
Department of Veterans Affairs (VA)
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Appendix 5:
HHS Agency and Other Federal Department Strategic Plans relevant to the draft strategic National Vaccine Plan
HHS:
U.S. Department of Health and Human Services Strategic Plan - FY 2007-2012
http://aspe.hhs.gov/hhsplan/2007/
ASPR:
HHS PHEMCE Strategy and HHS PHEMCE Implementation Plan
http://www.hhs.gov/aspr/barda/phemce/enterprise/strategy/index.html
Draft BARDA Strategic Plan for Medical Countermeasure Research, Development, and Procurement
http://www.hhs.gov/aspr/barda/phemce/enterprise/strategy/bardaplan.html
CDC:
National Immunization Program Strategic Plan 2000-2005
http://vyww.cdc.gov/ncird/downloads/strategic-plan.rtf
Immunization Information Systems Strategic Plan 2002-2007
http://www.cdc.gov/vaccines/programs/iis/activities/strategic-plan.htm
CDC Global Immunization Strategic Framework 2006-2010
http://www.cdc.gov/vaccines/programs/global/downloads/gisf-2006-2010.pdf
FDA:
FDA Strategic Action Plan, Fall, 2007
http://www.fda.gov/ope/stratplan07/stratplan07.htm
ODPHP:
HealthyPeople 2010
http://www.healthypeople.gov/Publications/
HealthyPeople 2020
http://www.healthypeople.gov/hp2020/
HRSA:
HRSA Strategic Plan FY 2005-2010
http://www.hrsa.gov/about/strategicplan.htm
NIH:
NIAID Strategic Plan for Biodefense Research, 2007
http://www3.niaid.nih.gov/topics/BiodefenseRelated/Biodefense/about/strategicplan.htm
NIAID: Planning for the 21st Century
http://www3.niaid.nih.gov/about/overview/planningPriorities/strategicplan/
Department of Agriculture
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USDA Strategic Plan 2005-2010
http://www.ocfo.usda.gov/usdasp/sp2005/sp2005.pdf
DoD:
U.S. Department of Defense Military Health System Strategic Plan
http://www.health.mil/StrategicPlan/Default.aspx
DARPA
Defense Advanced Research Projects Agency Strategic Plan 2007
http://www.darpa.mil/body/pdf/DARPA2007StrategicPlanfinalMarchl4.pdf
DoJ
U.S. Department of Justice Strategic Plan 2007-2012
http://www.usdoj.gov/jmd/mps/strategic2007-2012/12/
VA:
VA Strategic Plan (2006-2011)
http://wwwl.va.gov/op3/docs/VA2011Plan.pdf
USAID:
Strategic Plan: Fiscal Years 2007-2012
http://www.usaid.gov/policy/coordination/stratplan_fy07-12.html
