Vaccine Purchase. Changes in federal and state health finance programs (including the creation of VFC and SCHIP) have improved access to vaccines for vulnerable populations within the private sector. Despite these improvements, many children continue to fall through the cracks of federal assistance programs, and new health care reforms, such as managed care, do not meet the complete immunization needs of children or adults who cycle through programs with short-term coverage arrangements. As a result, a continuing need for government-purchased vaccines remains within each state. The federal government currently spends more than $650 million annually on vaccine purchases, predominantly for childhood vaccines.3 The states estimate that they will collectively spend an additional $109 million for vaccine purchases in 2000. This combined effort appears to be sufficient to meet the current vaccine needs of uninsured and Medicaid children, but may be inadequate if new vaccines are recommended by ACIP and if initiatives to improve adult coverage levels are launched.4

States are encouraged to expand their role in purchasing vaccines to meet the needs of vulnerable underinsured populations who are not eligible for programs such as VFC or SCHIP. This role can be fulfilled in one of two ways: by purchasing additional vaccines (the committee suggests an increase of $11 million) or by requiring all private insurers within the state (including Employee Retirement Income Security Act [ERISA]-preempted health plans) to provide all ACIP-recommended vaccines to their members in accordance with state immunization standards. Federal legislation would be required, however, to establish a mandate for the inclusion of childhood immunization benefits in all private insurance plans.5

Government expenditures for adult vaccines are currently very low (less than $4 million in federal funds in FY 2000; state estimates are not available). New vaccines are being considered for adult populations, and greater emphasis is being placed on the importance of vaccines for high-risk adults under age 65 with chronic diseases (e.g., diabetes or renal failure). Additional funds will be required to support these purchases to meet residual needs among adults who lack private or public insurance coverage. As discussed in Chapter 3, the purchase of vaccines annually for the high-risk uninsured adult population aged 18–64 requires about $19 million annually for influenza vaccine and about $24.2 million for the one-time purchase of pneumococcal vaccine. If the federal government were to absorb these combined costs, an annual increase of about $50 million in the Section 317 vaccine purchase budget would be required. Future changes to the adult immunization schedule are likely to increase these costs.

As changes occur in the vaccine schedule, the pool of federal and state funds allocated for vaccine purchase will need to expand to allow the

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