This guest post is presented by Maximus, sponsor of APHA’s 2022 Annual Meeting blog. Its Center for Health Innovation offers programs and services to help governments improve public health infrastructure so that they can respond to population health needs and emerging public health threats.

Amber Bickford Cox, Ph.D., MPH, senior director of public health at Maximus, shares ideas on the importance collaboration between state and federal agencies in vaccine distribution.

Three full school years have passed since COVID-19 disrupted the 2019-2020 school year. Since then, vaccine-preventable disease (VPD) coverage (as well as measures of academic performance) have struggled to recover from the significant impacts of the pandemic. With most kids back in classrooms these days, local public health agencies are being alerted by the Centers for Disease Control and Prevention to the risk of VPD outbreaks caused by lagging vaccine coverage.

State and federal governments are collaborating to support a vaccine policy and delivery ecosystem that reaches every community and ensures all children are protected from easily preventable diseases when they attend school.

The U.S. vaccine ecosystem requires federal and state agencies to work together to provide guidance and support for the local implementation of programs that identify and vaccinate children and families. Federal agencies like the Food and Drug Administration and CDC ensure a safe and reliable supply of childhood and adult vaccines. They conduct and support ethical and rigorous scientific research, transparent regulatory reviews, guideline development and accessible educational programs.

A significant correlation of a child's low vaccine coverage is family instability, and we know that parents with economic, housing and employment instability also have irregular access to medical care and health insurance. For this reason, the CDC has adopted the public health principle that funding vaccines is the most cost-effective way to prevent disease. According to the CDC, Every dollar invested in the U.S. childhood immunization program reaps $10 in societal savings and three dollars in direct medical savings.

Most adults pay for their vaccines with private insurance or out-of-pocket. Still, because children are most vulnerable to outbreaks and are often responsible for spreading preventable infections to parents and friends, state and federal governments have learned to take a more proactive approach to ensure that all children have access to vaccines regardless of their guardian's work or insurance status. State and federal funding helps provide vaccine access at public health departments, which often have a vaccine clinic, or through Federal Qualified Health Centers and Rural Health Clinics.

On-the-ground implementation of vaccinations in the U.S. health system uses a "medical home" philosophy, meaning most kids get vaccinated in their pediatrician's office rather than through school clinics or community events. This model builds parental vaccine confidence through the relationship with the clinician and permits billing for vaccines through private health insurance companies. However, this system faces challenges in reaching children who lack adequate insurance coverage or access to vaccines and medical care due to social or economic reasons.

State health departments take the lead in monitoring and assessing vaccination rates and tracking outbreaks in their communities. State programs responsible for distributing aid to low-income families are also ideal partners for identifying families needing assistance accessing or affording vaccines. Two relevant programs — Vaccines for Children and Section 317— are responsible for more than half of all vaccines provided to children each year, and a new national program proposed by the Biden Administration, Vaccines for Adults, would provide similar support to uninsured and under-insured adults.

Vaccines for Children is a federally funded entitlement program that provides vaccines at no cost to eligible children by providing CDC-recommended vaccines to participating program providers and grantees, the state health departments and through tribal and territorial agencies. The CDC does this by purchasing and sometimes stockpiling vaccines at a discounted rate, negotiated to between 15% and 70% below the list price.

Section 317 of the Public Health Service Act, first passed in 1962, helps purchase vaccines to meet priority populations. Discretionary funding under the Section 317 Immunization Program supports local, state and national program operations. It provides over $680 million in federal grants to state, local and territorial public health agencies to support program operations and vaccine purchases nationwide. Most of the program's funding supports foundational functions such as vaccine effectiveness studies, immunization registries, disease surveillance, outbreak detection and response, vaccine coverage assessment, and vaccine safety and provider education programming. Estimates are that these programs are still underfunded by at least $750 million.

At present, a smaller portion of the existing resources support vaccine purchases for adult immunization initiatives. However, an additional program would enhance the current focus on improving national vaccination rates across the lifespan — especially among priority populations. Expanding the vaccine policy ecosystem will help address unmet needs in older adults who are economically and socially vulnerable, and at-risk communities because lower rates of infectious disease in the country benefits everyone. The proposed Vaccines for Adults Program would establish mandatory funding of $11 billion over 10 years to purchase and deliver vaccine services to more than 27 million uninsured Americans.

The Imperative for Unified Action

As we navigate the complexities of public health in a post-pandemic world, collaboration between state and federal agencies in vaccine distribution is essential. The cost-effectiveness of such programs is clear, and the societal benefits are immense. It is imperative for senior government officials to leverage this multi-agency ecosystem to ensure equitable vaccine access, particularly for our most vulnerable populations. The time for concerted action is now, with the potential to not only improve childhood vaccination rates but also to lay the groundwork for more comprehensive adult vaccination initiatives. Failure to act risks exacerbating health care inequalities and leaves us ill-prepared for future public health challenges.

As a leader in providing health and human services to state and federal clients, Maximus has the public health and clinical subject-matter expertise needed to collaborate with the state, local and federal vaccine ecosystem.

As a strategic partner to governments, Maximus offers tailored solutions that address the complexities of vaccine distribution in the U.S. Maximus optimizes government vaccine tracking and delivery systems, identifies under-vaccinated populations for targeted interventions and provides operational support to state and local public health departments.

APHA’s Annual Meeting and Expo in Atlanta includes several presentations by experts in business process management and data analytics from the Maximus Center for Health Innovation.

Photo courtesy Maximus