Vaccines for Children Program entitling children to protection

October 2006

Vaccines are considered one of the most, if not the most, effective and cost-effective prevention measures.

New vaccines and new vaccine recommendations offer the opportunity to prevent even more infectious disease burdens.

In the past two years the vaccination schedule has expanded to include newly licensed vaccines against meningococcal disease, pertussis, rotavirus and human papillomavirus.

Recommendations have also expanded to include universal vaccination against hepatitis A for all children and against influenza for 24-59 month old children.

Developing, producing and distributing new vaccines is costly.

These prices have substantially increased as have the resources needed to vaccinate each child.

For example, in 1987, the cost, based on catalog prices, to fully vaccinate a child was $116. In contrast, in August 2006, the cost was $1,704. These expenses represent a major obstacle to access to vaccines for people who lack insurance, who would either have to pay out of pocket or forgo vaccination. It is for the latter group that the Vaccines for Children (VFC) program was created.

A fundamental component of the Childhood Immunization Initiative (CII) of 1993 was to eliminate financial barriers to access to vaccines.

The CII was developed in response to a major resurgence of measles between 1989 and 1991 during which more than 55,000 people were reported to have measles, more than 11,000 were hospitalized, and 123 died. The outbreak disproportionately affected unvaccinated preschool children, particularly those living in inner cities and members of racial and ethnic minority groups. One factor leading to underimmunization was that private physicians were referring patients who could not pay for vaccines out of their practices to public health department clinics for free vaccines. This practice not only broke up the medical home, but also established fears that many of these children would not make the extra visits and thus, remain unimmunized.

The VFC was established through the Omnibus Budget Reconciliation Act of 1993 and became effective in October 1994. Its goal was to provide “state of the art” recommended vaccines to eligible children in their medical home.

Covered children include individuals through 18 years of age who are: 1) Medicaid-eligible, 2) uninsured (no insurance whatsoever), and 3) Alaska Natives/American Indians. In addition, children who are underinsured (have insurance that does not cover immunization) can receive VFC-funded vaccines, but only at Federally Qualified Health Centers or Rural Health Centers, a limited number of clinics that receive support from the Health Resources and Services Administration (HRSA).

In 2001, the CDC determined that approximately 45% of young children were eligible for VFC. Vaccines covered by the VFC are established by the Advisory Committee on Immunization Practices (ACIP). Once voted into the VFC, funds automatically become available through Medicaid as an entitlement for children covered under the recommendation.

Thus, funding for vaccines does not have to go through the annual appropriations processes of both the executive and congressional branches of government, which eliminates the uncertainties associated with those processes. Before vaccines can actually be purchased and distributed, the CDC must negotiate a federal contract with the relevant manufacturer or manufacturers.

The VFC program is administered by the CDC through state and local health departments (see www.cdc.gov/nip/vfc/provider/provider_faqs.htm#2). Such agencies are responsible for enrolling providers into the program, taking vaccine orders and ensuring vaccines are delivered, assessing and improving vaccine storage and handling for VFC providers, and assuring vaccines are used only for eligible children.

Participating providers are asked to have parents fill out a simple form concerning eligibility. This is all self-declared by the parent and there is no obligation for the provider to verify the information.

Joining VFC has the following advantages: 1) eligible children can be served in their medical home, receiving critical recommended vaccines; 2) costs to the practice are minimized because there is no need to advance private funds for inventory to start vaccination of VFC eligible children. The program provides all needed vaccines; 3) paper work is minimal; 4) vaccine ordering is easy and 5) joining VFC establishes a partnership between private medicine and public health. Public health workers can review and recommend improvements in practices to achieve higher levels of coverage in the patients served. As of 2003, there were 31,000 private provider sites and 11,400 public provider sites participating in the VFC program.

Providers at these sites vaccinate children in their practices with VFC or other government vaccine or private purchase vaccine, depending on the child’s insurance status. Collectively, these providers vaccinate 90% of young children.

Despite the strengths of VFC, there are a number of challenges.

First, the program does not cover administration fees, although such fees can be collected for children enrolled in Medicaid. Second, there are caps on administration fees that may be charged to other children based on usual and customary charges. However, no one can be denied vaccines for inability to pay the administrative fee. Finally, many children without adequate insurance coverage are not eligible for VFC at the great majority of provider sites, including those who are underinsured and children whose vaccines are covered by insurance but who have large deductibles.

Despite these challenges, VFC has made a major contribution to protecting some of our neediest children from vaccine-preventable diseases and in doing so, is helping to protect our communities from outbreaks of these diseases.

More information is available at www.cdc.gov/nip/vfc.

For more information:

• Lance Rodewald, MD, is Director of the Immunization Services Division at the National Center for Immunization and Respiratory Diseases, CDC, and Walter Orenstein, MD, FAAP, is Assistant Professor of Medicine at Emory University School of Medicine.