Strengthening the PublicPrivate Immunization Partnership to Assure Access

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Strengthening the Public-Private
Immunization Partnership to Assure Access
Availability
Financing Vaccines in the 21st Century
EDGAR K. MARCUSE, MD, MPH, FAAP Childrens
Hospital and Regional Medical Center University
of Washington ed.marcuse_at_seattlechildrens.org
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IOM Report Conclusions
1, 3 Disparities in access exist and gaps in
insurance benefits contribute to them. 4
Financial incentives are needed to assure stable
vaccine supply and RD. 2 To assure equitable
access sustain investment in RD, alternatives
to current pricing and purchasing are required.
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DISPARITIES IN VACCINE ACCESS Insurance Coverage
for Immunization
Covered
Insurance status Private Public Underinsured Unins
ured
Children lt5 yrs 55 34 11
Adults 16 9 59 17
Adapted from Financing Vaccines, IOM 2003
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Childhood Vaccine Supply Policy Public
Sector Source CDC 4/15/03
NYC
DC
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Hierarchy of Vaccine Recommendations

• Mandated vaccines measles, polio
• Recommended vaccines pneu conj
• Elective vaccines mening PS, influenza for
  healthy children, adults, hepatitis A
  non-endemic areas

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Link Hierarchy of Recommendations to Funding

• Elective vaccine patient or insurer
• Recommended vaccines all insurers cover
  private, ERISSA, public
• Mandated vaccines government

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• Government pays for vaccines of principally
  public health (versus individual health)
  importance such as
• measles, diphtheria, polio for all citizens and
  for recommended vaccines for uninsured.

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• Differentiate health risks benefits for the
  individual and for the community

• What constitutes a public health risk or benefit?

- Contagion or epidemic - Illness, injury,
disability, death - Adverse effect on children -
Cost of care, disability
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• What disease risk coupled with what assurance of
  vaccine efficacy and safety justifies
• - a universal recommendation?
• - a mandate?

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Societal Value of Vaccines
Benefit to society of individual immunization

• Community (herd) immunity
• Reduced medical, public health costs due to
  disease prevention
• Enhanced quality and length of life
• Improved productivity

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Trade offs who decides?

• Vaccines versus
• other public health benefits
• other health benefits
• other public priorities

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