June 12, 2017
The Honorable Mitch McConnell
Majority Leader
United States Senate
S-230 U.S. Capitol Building
Washington, DC 20510

The Honorable Orrin Hatch
Chairman
Senate Finance Committee
219 Dirksen Senate Office Building
Washington, DC 20510
The Honorable Lamar Alexander
Chairman
Senate HELP Committee
428 Dirksen Senate Office Building
Washington, DC 20510
The Honorable Michael Enzi Chairman
Senate Budget Committee
624 Dirksen Senate Office Building
Washington, DC 20510

Dear Majority Leader McConnell and Chairmen Hatch, Alexander, and Enzi,
As members of the Adult Vaccine Access Coalition (AVAC), we encourage you to assure Americans of all ages full access to recommended immunizations that improve health and protect lives as you and your colleagues draft Senate health care reform legislation.
AVAC includes more than fifty organizational leaders in health and public health who are committed to overcoming the barriers to adult immunization. We believe improving access to and utilization of adult immunizations must be a top priority.
Specifically, Congress should support:

First dollar coverage for recommended vaccines through private coverage.

Immunization has demonstrated “effective prevention” in reducing rates of morbidity and mortality from a growing number of preventable conditions and has been proven to improve health in a cost-efficient manner. While the standards for adult immunization practice are widely accepted, the value of vaccines in reducing the health and economic burden of vaccine preventable conditions is not always fully recognized. Yet, the cost of vaccine-preventable disease among U.S. adults is significant – an estimated $9 billion1 to $26 billion2 annually. Studies show removing cost barriers increases immunization rates. Section 2713 of the Affordable Care Act, advanced access to immunizations by ensuring group and individual private health plans provide “first dollar coverage” through in-network providers of vaccines routinely recommended by the Advisory Committee on Immunization Practices (ACIP). Coverage for vaccines is critical to our nation’s health and economic security. The Senate should protect coverage of ACIP-recommended vaccines at no extra cost to consumers.

1 http://content.healthaffairs.org/content/early/2016/10/07/hlthaff.2016.0462
2 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486398/
Adequate funding for federal, state and local immunization programs.

Since their inception, vaccines have eradicated smallpox and polio in the US and have dramatically reduced the spread of many more crippling and potentially life-threatening diseases such as diphtheria, tetanus, measles, mumps, and rubella. Vaccines also prevent the spread of common infectious and potentially fatal diseases such as chickenpox, influenza, hepatitis A, hepatitis B, meningococcal disease, pneumococcal disease, and whooping cough (pertussis). Vaccines not only help protect the immunized person but also those around them who may not be able to be immunized because they are too young to be vaccinated or suffer from a health condition that prevents them from being immunized.

Discretionary spending caps enacted through the Budget Control Act have resulted in an increasing percentage of essential public health functions being financed through the Prevention and Public Health Fund (PPHF). Today, PPHF dollars make up roughly half of the CDC Immunization Program budget, which directly supports state and local immunization infrastructure, preparedness, and response activities. These resources enable state and local health departments to carry out a variety of activities vital to the prevention, detection and mitigation of vaccine preventable conditions. Grants from the CDC Immunization Program are utilized not only for the purchase of vaccines for children, adolescents and adults, but also to support a number of other important activities, including responding to the growing number of vaccine preventable disease outbreaks.

A significant reduction in funding could lead to lower vaccination rates, which could have serious consequences for communities across the country at a time when outbreaks of preventable conditions—from mumps in Seattle to measles in Texas—are on the rise. This funding is also essential for emerging threats, such as Zika virus, for which the development of a new vaccine is under way. The Senate must ensure adequate funding for immunization programs and activities that are on the front lines of protecting and preserving the health of children, adolescents and adults across the country.

Improving access to immunization for low-income adults.

Medicaid plays a key role in disease prevention by facilitating access to a range of community providers and recommended adult vaccines. For low-income, vulnerable populations, first dollar coverage of vaccines is integral to accessing these cost-effective and potentially lifesaving services. Only 36 Medicaid programs provide comprehensive coverage of adult vaccines in accordance with ACIP recommendations and just 17 of these programs offer first dollar coverage.i Moreover, inadequate provider reimbursement hinders beneficiary access to vaccines. Providers are challenged to offer vaccines when Medicaid payment rates do not cover the upfront purchase and administration costs. Immunization coverage under Medicaid should reflect the fact that infectious diseases do not stop at state lines. AVAC urges the Senate to protect access to immunizations for low-income populations; states should provide first dollar coverage for ACIP-recommended vaccines to Medicaid beneficiaries; and providers who care for them are adequately reimbursed.

Immunization plays a critical role in the health and security of our country. We therefore urge you to prioritize support for immunization coverage, state and local vaccine infrastructure, and Medicaid coverage of vaccines. If you have questions or would like more information, please contact the AVAC leadership at 202-540-1070 or info@adultvaccinesnow.org.

Sincerely,
Alliance for Aging Research
American Pharmacists Association
Every Child By Two/Vaccinate Your Family
Hep B United
Hepatitis B Foundation
Immunization Action Coalition (IAC)
Infectious Diseases Society of America (IDSA)
March of Dimes
National Association of Chain Drug Stores
National Association of County and City Health Officials
National Foundation for Infectious Diseases (NFID)
Novavax
Takeda Vaccines, Inc.
The Gerontological Society of America
Trust for America’s Health
i Trust for America’s Health. 2016 Ready or Not Report. http://healthyamericans.org/assets/files/TFAH-2016-ReadyOrNot-FINAL2.pdf