Strengthening the Delivery of New Vaccines for Adolescents

A National Stakeholders' Meeting

Washington DC

June 2-3, 2005

History

• Oct 2004 – Meeting “conceived” at NVAC meeting

• Oct 2004 – Feb 2005– Organizing committee formed– Background topics developed and working groups

formed and asked to write draft papers

• Mar 2005 – June 2005– New members in organizing committee– Overarching questions added– Facilitators added

Goals of the Meeting

• Identify approaches to effectively and efficiently increase the proportion of adolescents who receive newly recommended vaccines

• Identify ways to integrate approaches with other adolescent health, education, and development programs

Organizations represented• Academy for Educational

Development• Agency for Healthcare

Research and Quality• Ambulatory Pediatric

Association• American Academy of Family

Physicians• American Academy of

Pediatrics• American Academy of

Physician Assistants• American College of

Obstetricians and Gynecologists

• American Medical Association• American Nurses Association• American Pharmacists'

Association• American Public Health

Association• American School Health

Association• Association of Immunization

Managers• Association of State and

Territorial Health Officers

Structure of the Meeting

• Background topics – Selected by NVAC before meeting

• The medical home• alternative settings (schools, high risk youth, others)• Legislation• prevention priorities• economic issues (cost-effectiveness and financing)• communication strategies

– Reviewed current and historical information on major policies options

– Summarized in presentations during plenary– Discussed during breakouts

Structure of the Meeting

• Overarching questions– Drawing on background material, suggest

possible directions for NVAC on:• Goals and evaluation• Delivery• Financing• Increasing demand

Goals and evaluation

• Questions– What should be the goals of a program to

deliver adolescent immunizations?– How will we evaluate the program?

Goals and evaluation (cont)

• Goal 1: Disease reduction– Reduce/eliminate the morbidity and mortality due to vaccine

preventable diseases among all adolescents– Evaluation: National and sentinel surveillance systems

• Goal 2: Vaccine coverage– Goal: Maximize vaccination coverage with universal access (no

disparities in subpopulations)– Evaluation: School requirements, insurance benefits, and

coverage levels• Goal 3: Comprehensive, integrated adolescent health

care– Goal: Use adolescent immunization to enhance the delivery of

comprehensive/integrated health care and health promotion – Evaluation: Adolescents who receive vaccination in conjunction

with comprehensive adolescent health care

Delivery

• Question:– Which approaches will most effectively and

efficiently increase the proportion of adolescents who receive newly recommended vaccines?

Delivery (cont)

• Oversight and needs assessment by local public health authorities

• What will be the dominant venue for adolescent immunization?– Approaches in primary care (medical home)

• Optimize delivery in this setting (~50% of kids)• Systematic approaches• Vaccination can be a hook to other preventive services

– Approaches in supplemental settings• Based on community needs assessment & resource mapping, bring

vaccines to the kids• Schools

– Build on and strengthen existing school health programs and curricula– Hold clinics during school day– Use of registries is essential

Delivery (cont)

• Approaches in supplemental settings (cont)– Pharmacies– Hard-to-reach populations

• Conduct special planning• Integrate into existing programs/services

Financing

• How will the public and private sectors pay for vaccination?

• Key assumptions:– Will need to be applied across a variety of

delivery settings– Private & public sources will likely need to be

blended– Needs may differ by vaccine because

delivery, coverage, public demand, and key stakeholders will differ by vaccine

Financing Stakeholders

• Insurers/Employers• Government• Industry• Partnerships• Patients/Parents• Providers/Provider Associations• Non-governmental organizations

Insurers/Employers

• Vaccines– Respond to employee

demand– Change business

practices regarding vaccines (eg, replacement system)

• Delivery– Finance delivery in

supplemental settings in collaboration with providers

Government

• Vaccines– Create incentives for

public, providers, employers/insurers

– Consider enhancement of existing incentives (eg, VFC reimbursement as pay-for-performance)

– New rules for excise taxes,– Matching state:federal

funds for vaccine purchase– Override ERISA– Increase funding in

317/VFC

• Delivery– Enhance operational

funding for 317/VFC– Support research re: cost-

effectiveness of delivery in supplemental settings

Industry

• Vaccines– Fund educational

campaigns to stimulate demand

– Consider price breaks for non-federal purchasers (eg, large employers, schools, counties)

• Delivery– Fund educational

campaigns to stimulate demand

Partnerships Led by Government

• Vaccines– Initiate education to prompt

demand and additional funding for purchase

– Promote adoption of model legislation regarding mandated vaccine benefits

• Delivery– Work with

employers/insurers to “set aside” part of capitation for adolescent vax in supplemental settings

– Work with state legislators to increase delivery financing

Increasing Demand for Adolescent Immunization

Demand

Question:

How Can We Enhance The Demand/Acceptance For Vaccines Among Adolescents, Parents, And Providers?

Demand

• Focus on 4 groups of vaccines– Catch up– High risk– Newly licensed; newly recommended– STI

Demand (cont)

– Some strategies are good for all vaccines while others are targeted to individual vaccines

– More research is needed about effective messages

– Need to coordinate messages with manufacturers

Selected questions to be considered by NVAC

• Medical home– Can we define specifics steps to further optimize delivery?

• Alternative (supplemental) settings– Are there any “best bets” for new vaccination partnerships among the

alternative health care settings regularly used by adolescents?– Should vaccination begin in selected schools (e.g. school based health

centers)?– Should schools be appraised as stand-alone immunization

opportunities?– Should we begin special efforts to reach youth who fall through the

safety nets?• Legislation

– Should we take a position on laws and consent?

Important questions to be considered in “next steps”

• Economics– Should obvious differences in cost-effectiveness enter

into policy?

• Prevention priorities– Can/Should we demonstrate that vaccination visits

are an important opportunity to provide other preventive services?

• Communication– Can we define an optimal strategies, especially when

manufacturers are likely to take the lead?

Important questions to be considered in “next steps”

• Goals– Can we define a common goal?

• Delivery– Should we begin to vaccinate in one or more types alternative

settings?

• Finance– What are novel financing mechanisms in public/private sectors– Can we define a direction to focus our attention amidst the sea

of barriers?

• Demand– Should we develop a communications blueprint?

Information Needed

• Explore current models of adolescent care delivery (US and abroad)

• Model different financing options (public and private)

• Acceptability of delivery options to different populations/stakeholders

Next Steps

• How to acquire needed information

• How to move the debate forward

• How to develop an action plan

• Convene cross-subcommittee working group?