Vaccines for Children Program
The Vaccines for Children Program (VFC) is a
History
From 1989 through 1991, a measles epidemic in the United States resulted in over 55,000 reported cases of measles, 11,000 measles-related hospitalization, and 123 deaths.[4] Upon investigation, Centers for Disease Control and Prevention (CDC) found that more than half of the children who had measles had not been immunized, despite seeing a health care provider.[5] In partial response to that epidemic, Congress passed the Omnibus Budget Reconciliation Act (OBRA) on August 10, 1993, creating the VFC Program; the VFC program officially became operational October 1, 1994.[6]
The Vaccines for Children program represented a major vaccine finance reform, working as a state-operated federal entitlement program that supplied both public and private providers with federally purchased vaccines. This integration of both the public and private sector benefitted all providers. Because private providers now had a role in the nation's immunization program, they, along with the public health sector, benefitted from the supply of vaccines at no cost, educational opportunities, and the ability to provide immunization services to patients without a need for referral.[7] As of 2019, there are over 44,000 doctors at 40,000 locations enrolled in the VFC program nationwide.[3]
Outcomes and impact
By eliminating or reducing cost as a barrier to vaccination, the VFC program encourages improved vaccination coverage among eligible children.[2] Increased vaccination protects not only vaccinated child themselves, but also indirectly protects those around them through herd immunity, which can slow or stop the spread of disease. Thus childhood vaccination, as opposed to vaccination later in life, is particularly effective as a means of controlling and preventing disease spread.[8]
The VFC program results in millions of immunizations each year. In 2010 alone 82 million VFC vaccine doses were administered to approximately 40 million children.[9] Due to the exponential impact of vaccination, it is difficult to separate the effect of the VFC from that of other state and federal immunization programs. For example, it is difficult (or perhaps impossible) to disentangle the effects of the VFC program and the increase in public school vaccination requirements that occurred during the 1990s and 2000s.[10] Thus, research primarily focuses the overall effect of increased childhood immunization that began in the mid-1990s, much (but not all) of which is owed to the VFC program.[citation needed]
The CDC estimates that among children born from 1994 to 2013 (that is, children born during the VFC-era), "routine childhood immunization... [will] prevent 322 million illnesses (averaging 4.1 illnesses per child) and 21 million hospitalizations (0.27 per child) over the course of their lifetimes and avert 732,000 premature deaths from vaccine-preventable illnesses". All told, vaccination among this birth cohort will prevent an estimated 8.9 million measles-related hospitalization and 507,000 diphtheria-related deaths.[11] These rates do not include prevented hospitalizations and deaths resulting from annual influenza immunizations, which the VFC also provides. Additionally, these estimates do not account for the rise in US population during this time period. Both of these factors have the potential to make the CDC's estimates artificially low.[citation needed]
The VFC program has also significantly helped close the vaccination rate gap between
Vaccination programs like the VFC are expensive, but they also result in significant cost savings through prevented hospitalization and doctor visits. Routine childhood vaccination among the 1994-2013 birth cohort is estimated to result in $107 billion in direct costs and $121 billion in social costs. In return, childhood vaccination results in the aversion of $402 billion in direct costs and $1.5 trillion in societal costs. This gives vaccination a net present value (net savings) of $295 billion and $1.38 trillion in direct and societal costs, respectively.[11]
Due to the VFC program, the
Program
The VFC program is funded through an approval by the
Patient eligibility
Children and adolescents are eligible if it is before their 19th birthday and if they meet one or more of the following criteria:[15]
- Medicaid-eligible
- Uninsured (lacking health insurance)
- Alaska Native
- Underinsured*
Based upon these guidelines, the CDC estimates that approximately 50% of children under 19 years old are eligible for VFC benefits.[11]
* Underinsured means that a child that is covered by some type of health insurance, but the insurance either does not cover any vaccines, covers only certain vaccines, or does cover some vaccines, but has a cap on the annual cost for vaccines*. Underinsured children and adolescents may only receive vaccines at sites that are federally qualified health centers (FQHCs) or rural health clinics (RHCs).[16] Each state has an administrative fee set by the state that can never be exceeded, of about US$15.[17]
As of 2018, many children have benefited from the VFC program, which has saved nearly 936,000 from preventable diseases. Many families are benefiting from this program as it covers vaccines and helps with the costs of vaccines for low-income families. Records indicate that from 1994 to 2012 after immunizations began to rise, diseases such as polio and hepatitis B decreased drastically.[11]
Covered vaccines
The Advisory Committee on Immunization Practices (ACIP) makes recommendations to the VFC program as to what are the most appropriate selection of vaccines and related agents for control of vaccine-preventable diseases in the civilian population of the United States.[18] VFC resolutions passed by the ACIP form the basis for VFC program policies on vaccine availability and usage. These resolutions may not necessarily match the general usage recommendations of the ACIP, but rather represent the rules that providers must follow for administering each specific vaccine under the VFC program.[19]
The following vaccines are included in the VFC Program:[15]
|
|
* Vaccines initially targeted by the VFC program in 1994.
** Vaccines added to the VFC program from 1995 to 2013.[11]
Latest changes
The VFC program has implemented several regulations to address the changing needs of grantees:
In attempts to address fraud and abuse, grantees must now submit a copy of the newly written fraud and abuse policy, which includes identification of staff responsible for these issues, to the CDC no later than December 31, 2007.[20]
The VFC program is also requiring the update of user profiles. Rather than having grantees do this task, the goal is to improve accountability and ensure accurate information about the population of eligible children.[20]
A larger and more recent enhancement aiming to improve vaccine management at multiple levels (federal, state, local) is the initiation of the Vaccine Management Business Improvement Project (VMBIP). This project aims to simplify the ordering and distribution projects of vaccines, implement a more efficient supply system, and enable direct delivery of vaccines to providers.[20]
References
- ^ United States Congress. "§ 1928 Program for Distribution of Pediatric Vaccines". Social Security Act. Retrieved March 10, 2019 – via U.S. Social Security Administration.
- ^ a b c "VFC Childhood Vaccine Supply Policy". Vaccines for Children Program (VFC). Centers for Disease Control and Prevention. February 18, 2016. Retrieved March 5, 2019.
- ^ a b c "VFC Home". Vaccines for Children Program (VFC). Centers for Disease Control and Prevention. February 18, 2016. Retrieved March 5, 2019.
- ^ PMID 24743661. Retrieved March 10, 2019.
- PMID 8273330.
- OCLC 756044361. Retrieved March 11, 2019.
- PMID 10429133.
- PMID 27408519.
- ^ Levinson, Daniel (June 2012), Vaccines for Children Program: Vulnerabilities in Vaccine Management (PDF), Department of Health and Human Services, Office of Inspector General, retrieved March 11, 2019
- ^ Carpenter, Christopher; Lawler, Emily (January 2017), Working Paper 23107: Direct and Spillover Effects of Middle School Vaccination Requirements (PDF), Cambridge, Massachusetts: The National Bureau of Economic Research, retrieved March 10, 2019
- ^ PMID 24759657. Retrieved March 10, 2019.
- PMID 24025754. Retrieved March 11, 2019.
- ^ Institute of Medicine (US) Committee on the Evaluation of Vaccine Purchase Financing in the United States (2003). "Executive Summary". Financing Vaccines in the 21st Century: Assuring Access and Availability. Washington, DC: National Academies Press.
- ^ DPI Research, Pediatric Vaccines Market: United States Industry Analysis, Trends, Opportunity, Market Size and Segment Forecasts, 2018 - 2025, Research and Markets, retrieved March 11, 2019
- ^ a b "VFC Detailed Questions and Answers for Parents". Vaccines for Children Program (VFC). Centers for Disease Control and Prevention. December 17, 2014. Retrieved March 12, 2019.
- PMID 19948587– via AAP News & Journals.
- ^ Cole, Megan (June 28, 2014). "The Vaccines for Children Program (VFC)". National Center for Health Research. Retrieved February 13, 2019.
- ^ "ACIP General Committee Information | Immunization Practices | CDC". www.cdc.gov. January 8, 2019. Retrieved March 12, 2019.
- ^ "ACIP Resolutions for Vaccines for Children Program". Vaccines for Children Program (VFC). Centers for Disease Control and Prevention. July 10, 2019. Retrieved April 6, 2020.
- ^ PMID 18051664.