JACKSONVILLE, FLA. — Financial and logistic barriers will limit the implementation and impact of human papillomavirus vaccine, Dr. Lance Rodewald said at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.
New vaccines incorporated into the child immunization schedule are typically adopted quickly across the nation. “For adolescents, we don't do as well,” Dr. Rodewald said. “For example, there is 74% coverage for the three shots for hepatitis B. It is better for MMR and Td [tetanus-diphtheria], but our adolescent platform is not well established now.”
To improve distribution to those at highest risk, family physicians, obstetricians and gynecologists, and other primary care providers will be encouraged to join the federal government's Vaccines for Children (VFC) program. VFC pays for vaccinations for certain vulnerable children through age 18 years, including those on Medicaid, Native Americans or Alaska natives, the uninsured, and those insured without a vaccine benefit.
Underinsured children are not covered by VFC, nor are they covered in most cases by a smaller federal program—Section 317—or state funding. “My confidence in government funding starts and stops at the VFC program,” said Dr. Rodewald, a pediatrician and director of the Immunization Services Division, National Immunization Program, at the Centers for Disease Control and Prevention.
“HPV [human papillomavirus] vaccine is certainly going to be delivered in a two-tiered system. There is no way around it unless something changes,” he said.
Because of inadequate state and Section 317 funding, many states cannot purchase vaccine for underinsured children, resulting in the two-tiered policy. “There is some indication the president might increase funding to include underinsured children who could get vaccinated at federal public health sites—but it's unlikely to happen this year,” he said.
Financing the HPV vaccine for women over age 18 is another challenge. “The provider may have to purchase adult vaccines up front and get reimbursed later. So there is a financial risk if the vaccine is not used,” Dr. Rodewald said.
The vast majority of Section 317 program funding, 95%, goes to vaccines for children. However, this means only 5% of Section 317 money pays for adult immunization, and state funding for adults is discretionary.
The financial considerations are not unique to HPV prevention. Other new vaccines likely coming soon include a second-dose varicella product and protection against shingles/postherpetic neuralgia, Dr. Rodewald said. “These new vaccines are great, but they come at a cost,” he said. The cost to protect each child has grown from $45 in 1985 to $155 in 1995 to $837 in 2006.
“The U.S. immunization system is highly effective and highly successful at protecting children from vaccine-preventable diseases,” Dr. Rodewald said. “But the most important stress in the U.S. system is financing access to the many new vaccines.”