Vaccination Financing: Program Vaccination Financing: Program Funding and PressuresFunding and Pressures

Vaccination Financing: Program Vaccination Financing: Program Funding and PressuresFunding and Pressures

AIM Program Managers MeetingAIM Program Managers MeetingNovember 19, 2008November 19, 2008

New Orleans, LANew Orleans, LA

Lance E. Rodewald, MDLance E. Rodewald, MD

Director, Immunization Services DivisionDirector, Immunization Services Division

National Center for Immunization and Respiratory Diseases, CDCNational Center for Immunization and Respiratory Diseases, CDC

GoalsGoals

Account for FY06 through FY08 actual Account for FY06 through FY08 actual operations fundingoperations funding

Project maximum and minimum Project maximum and minimum funding for FY09 operationsfunding for FY09 operations

Project possible vaccine funding for Project possible vaccine funding for FY09FY09

Section 317 Operations Funding: Section 317 Operations Funding: FY06 – FY08FY06 – FY08

FY06 FY07 FY08

New Money 169,424,191 175,587,975 176,775,795

DA Other 2,338,817 2,231,103 2,029,275

Carryover Awarded 23,125,166 17,698,692 4,999,821

Total 194,888,174 195,517,770 183,804,891

VFC Non-Vaccine Funding: VFC Non-Vaccine Funding: FY06 – FY08FY06 – FY08

FY06 FY07 FY08

OPS 46,620,538 48,816,452 41,682,574

AFIX 34,900,000 36,295,927 36,822,071

DA Other 1,803,018 132,498 Carryover

TOTAL 83,323,556 85,112,379 78,637,143

Total Operations Funding: Total Operations Funding: FY06 – FY08FY06 – FY08

FY06 FY07 FY08

New Money 255,086,564 262,931,457 257,442,213

Carryover Awarded 23,125,166 17,698,692 4,999,821

Pan Flu 15,422,284Total to

Grantees 278,211,730 280,630,149 277,864,318

Section 317 Operations Funding: Section 317 Operations Funding: FY08 – FY09 (projected)FY08 – FY09 (projected)

FY08 FY09 Max FY09 Min

New Money 176,775,795 175,111,886 169,858,529

DA Other 2,029,275

Carryover Awarded 4,999,821 17,364,000 17,364,000

Total 183,804,891 192,475,886 187,222,529

VFC Non-Vaccine Funding: VFC Non-Vaccine Funding: FY08 – FY09 (projected)FY08 – FY09 (projected)

FY08 FY09 Max FY09 Min

OPS 41,682,574 34,400,000 33,368,000

AFIX 36,822,071 37,705,454 37,705,454

DA Other 132,498 169,939 169,939

Carryover 391,735 391,735

TOTAL 78,637,143 72,667,128 71,635,128

Total Operations Funding: Total Operations Funding: FY08 – FY09 (projected)FY08 – FY09 (projected)

FY08 FY09 Max FY09 Min

New Money 257,442,213 247,217,340 241,101,922

Carryover Awarded 4,999,821 17,755,735 17,755,735

Pan Flu 15,422,284 15,830,061 8,006,000Total to

Grantees 277,864,318 280,973,075 266,863,657

Operations Funding Time LineOperations Funding Time Line

Continuing resolution until March 6, 2009 for Section Continuing resolution until March 6, 2009 for Section 317 and Pandemic Influenza funding; VFC not 317 and Pandemic Influenza funding; VFC not subject to CRsubject to CR

First roundFirst round– All carryoverAll carryover

– Almost all VFC fundingAlmost all VFC funding

– 43% of Section 317 and Pan Flu funding43% of Section 317 and Pan Flu funding

Because of CR, we are unlikely to be able to Because of CR, we are unlikely to be able to accomplish all funding in 2 roundsaccomplish all funding in 2 rounds

Operations Funding AwardsOperations Funding Awards

We will provide grantees with separate accounting for We will provide grantees with separate accounting for categoriescategories– Section 317Section 317

– VFC-AFIXVFC-AFIX

– VFC operationsVFC operations

– Pandemic influenzaPandemic influenza

Accounting will includeAccounting will include– First round amountFirst round amount

– Projected full-year minimumProjected full-year minimum

– Projected full-year maximumProjected full-year maximum

Goal is to allow as much information as early as possible in the Goal is to allow as much information as early as possible in the fiscal yearfiscal year

VFC Vaccine: FY08VFC Vaccine: FY08

FY08 approved target budgetFY08 approved target budget– Based on PES/VOFABased on PES/VOFA

– $3.004 B$3.004 B

Emergency request for additional $113 M was Emergency request for additional $113 M was approved by OMB and included into FY08approved by OMB and included into FY08

FY08 spent VFC vaccine budgetFY08 spent VFC vaccine budget– Based on vaccine ordersBased on vaccine orders

– $2.681 B (89% of approved target amount)$2.681 B (89% of approved target amount)

VFC and Section 317 Vaccine VFC and Section 317 Vaccine Budget Spending: FY08Budget Spending: FY08

VFC Section 317

Target $ 3,004 M $ 273 M*

Routine Spending

$ 2,681 M $ 247 M

Hepatitis B Initiative

--------- $ 16 M

Total Budget Remaining

$ 323 M (11%)

$ 11 M(4%)

* Includes Base plus carryover funding

VFC Vaccine: FY09VFC Vaccine: FY09

Approved for FY09Approved for FY09– $2.442 B$2.442 B

Projected spending in FY09Projected spending in FY09– $3.019 B$3.019 B

– Based upon two projection methodsBased upon two projection methods PES/VOFAPES/VOFA Forward projection modelForward projection model Results nearly identicalResults nearly identical

– Additional projected spending from increased vaccine Additional projected spending from increased vaccine use and new ACIP recsuse and new ACIP recs

Shortfall will be requested in DecemberShortfall will be requested in December

VFC and Section 317 Vaccine VFC and Section 317 Vaccine Funding to Immunization Funding to Immunization Programs: 1990 - 2008Programs: 1990 - 2008

$0

$500,000,000

$1,000,000,000

$1,500,000,000

$2,000,000,000

$2,500,000,000

$3,000,000,000

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Section 317 VFC

FUNDING TRENDSFUNDING TRENDSSection 317 ops and vaccineSection 317 ops and vaccine

Operations FundingOperations Funding

End of VFC adolescent vaccination fundingEnd of VFC adolescent vaccination funding

End of distribution funding in operations (with few End of distribution funding in operations (with few exceptions: PIs and AK)exceptions: PIs and AK)

Increasing categorizationIncreasing categorization– VFC-AFIXVFC-AFIX

– VFC operations/orderingVFC operations/ordering

– Pandemic influenzaPandemic influenza

Separate accounting for categoriesSeparate accounting for categories

New Section 317 Report to New Section 317 Report to CongressCongress

Third year this annual report was requested Third year this annual report was requested by both Appropriations Committeesby both Appropriations Committees

New request asked for same methodology for New request asked for same methodology for new reportnew report

NVAC recommended thatNVAC recommended that– Congress should continue to ask for this report Congress should continue to ask for this report

every yearevery year

– Congress should use the report in their Congress should use the report in their appropriations considerationsappropriations considerations

OMB Requested Section 317 OMB Requested Section 317 BenchmarksBenchmarks

Funding proposals for transition documentFunding proposals for transition document

CDC proposals based on Section 317 Report to CDC proposals based on Section 317 Report to CongressCongress– Adolescent vaccinationAdolescent vaccination

– Adult vaccinationAdult vaccination

– School-age influenzaSchool-age influenza

– Maintaining acceptanceMaintaining acceptance

Prospects unknown, but shows the helpfulness of Prospects unknown, but shows the helpfulness of the 317 Report for articulating projects with great the 317 Report for articulating projects with great value to society that are consistent with our programvalue to society that are consistent with our program

QUESTIONS AND QUESTIONS AND DISCUSSIONDISCUSSION

Topics for QuestionsTopics for Questions

2-tiered systems2-tiered systems

AccountabilityAccountability– Fraud and abuse algorithmFraud and abuse algorithm

– PESPES

– AIM Accountability WorkgroupAIM Accountability Workgroup

Tracking vaccine spendingTracking vaccine spending

VMBIP savingsVMBIP savings

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