IDSA 2011: Vaccination Successes and Challenges, Part I

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Larry Pickering, MD, described immunization as a great public health triumph and talked of how the US maintains high vaccination rates.

BOSTON, MA— In a lecture to the annual meeting of the Infectious Diseases Society of America, Larry Pickering, MD, senior advisor to the director of the National Center for Immunization and Respiratory Disease of the Centers for Disease Control and Prevention and professor of pediatrics at Emory University School of Medicine, described immunization as one of the greatest public health triumphs of the 20th century, but warned that it faces significant challenges going forward.

Among the successes attributable to vaccines, Pickering explained, are global eradication of smallpox, elimination of polio in most of the world, and total elimination of measles and rubella from the US and the Americas. By way of illustration, he showed maps of hepatitis A rates across the US in 1987-97 and 2009—the former blotchy with areas experiencing outbreaks and the latter almost entirely clear.

The health benefit of vaccines is clear, Pickering noted, with 20 million cases of disease and 42,000 deaths prevented for each US birth cohort. But vaccination also brings great economic benefit, with a net saving of $13.6 billion in health care expenditures and $68.9 billion in societal expenditures per birth cohort.

Nonetheless, maintaining our immunization program remains an ongoing challenge. Each year, 4 million babies are born and must be vaccinated. Among the hurdles is the initial cost of vaccines, with the price tag for all recommended vaccinations from birth to age 18 having risen from $370 in 2000 to $1,332 for males and $1,620 for females in 2011.

There are a number of programs that help ensure that all children in the US have access to vaccines. Of these, Pickering highlighted the CDC’s Vaccines for Children program, implemented in 1994, which provides vaccines to approximately 45% of children, including those who are uninsured and eligible for Medicaid. Vaccines are purchased by the government and given to private providers for use on eligible children with no up-front outlay required on the part of providers—a key feature as the median cash value of providers’ vaccine inventories is almost $60,000.

As a result, Pickering explained, vaccination rates for almost all vaccines recommended for children under three have either hit their goal of at least 90% coverage or are well on their way toward that goal. Growth in coverage for adolescents has been a bit slower, with the HPV vaccine lagging in particular.

To read our article on the rest of Pickering's lecture, click here.

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