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PEDIATRICS Vol. 112 No. 3 September 2003, pp. 671-672

COMMENTARY

Do We Need a Structural Engineer to Redesign Our Vaccine Infrastructure?

Steve Berman, MD, FAAP

University of Colorado School of Medicine and Children’s Hospital
Denver, CO 80218

Abbreviations: VFC, Vaccines for Children (program)

The first 20% of the full text of this article appears below.

Our current vaccine infrastructure is being stressed by the increasing costs of vaccines. Currently the cost of the vaccines that protect children from 11 diseases is about $400 at discounted private sector prices and $600 at full private sector prices. Adding varicella and pneumococcal conjugate vaccine to the federal Vaccines for Children (VFC) program doubled the annual budget from $500 million to $1 billion. More expensive vaccines are in the pipeline. Cracks are appearing and growing in the foundation that supports our vaccine infrastructure. Do these cracks indicate structural weaknesses that can cause a major collapse when we attempt to add new and expensive vaccines in the future? Is our foundation flexible enough to provide sufficient incentive to the pharmaceutical industry to invest in additional research, development, and licensing of new vaccines? Can we patch these cracks and possibly shore up the foundation with some new girders, or must we totally redesign the foundation to bear more weight to avoid a future collapse?

How we address these questions has enormous health policy implications for the United States. Although only a small part of the entire health care enterprise, our vaccine infrastructure is extensive with complex financing, distribution, and administration components. Financing and purchasing involves public federal, state, and local expenditures as well as private health plan and individual "out-of-pocket" expenditures. Distribution includes vaccine manufacturers, federal and state purchasers, health plans, private distributors, local public health departments, hospitals, clinics, and physicians and involves monitoring, ordering, shipping, and storage of vaccines. Vaccine administration is the outcome of complex interactions among the health plan, clinical setting, and family. Whether vaccines and pediatric preventive care are covered benefits, and if so, whether they are subject to cost-sharing requirements such as deductibles and/or co-payments is . . . [Full Text of this Article]

Address correspondence to Steve Berman, MD, Children’s Hospital, 1056 E 19th Ave, B032, Denver, CO 80218. E-mail: berman.stephen@tchden.org




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Proposals would expand vaccine coverage, improve reimbursement: IOM report recommends government involvement
AAP News, October 1, 2003; 23(4): 174 - 174.
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