HOUSE APPROPRIATIONS BILL

On July 15, the House Appropriations Committee approved the fiscal year 2022 (FY22) Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) appropriations bill by a vote of 33-25 along party lines.  The bill passed the House Floor on July 29 by a vote of 219-208. The $253.8 billion spending bill marks an historic increase of $55.2 billion (28 percent) above the fiscal year 2021 (FY21) enacted funding level. The legislation includes nearly $10.6 billion for the Centers for Disease Control and Prevention (CDC), an increase of over $2.7 billion (35 percent) above the FY21 enacted funding level and $1 billion above the President’s FY22 budget request. The bid constitutes the largest proposed funding increase for CDC in two decades. The bill will be included in a seven-bill omnibus package which will be sent to the floor and voted on by the end of the month.

The bill contains a substantial funding boost for the CDC’s Section 317 Immunization Program. The legislation appropriates just under $718.6 million to the program, an increase of nearly $105 million (17 percent) over the FY21 enacted funding level and just under $5 million above the President’s budget request. In addition to the robust funding increase, the bill report includes the following language relevant to the 317 program:

  • Adult Hepatitis B Vaccination.—The Committee is concerned about the rate of adult hepatitis B vaccination, as low rates of vaccine coverage among adults represent a missed opportunity. The Committee urges CDC to develop a plan to achieve adult hepatitis B vaccination goals (pg. 79).

  • Cost Estimates.—The Committee looks forward to reviewing the fiscal year 2023 report on estimated funding needs of the Section 317 Immunization Program and urges that the report be updated and submitted not later than February 1, 2022. The updated report should include an estimate of optimum State and local operations funding, as well as a discussion of the role of the 317 Program, as coverage for vaccination under public and private resources continues to evolve. The fiscal year 2023 report should include specific information on the estimated cost to fully address evidence-based public health strategies that could be funded through CDC to improve coverage for human papillomavirus and influenza (pg. 79).

  • Enhancing 317 Immunization Program.—The Committee includes an increase of $99,925,000 to enhance adult immunization. The COVID–19 pandemic illuminated a variety of gaps in our public health capacity, including the need for a comprehensive adult immunization program. This expansion holds the potential to meet longstanding issues of inequity in protection from vaccine-preventable diseases and to address vaccine hesitancy (pg. 80).

  • Immunization Rates.—The Committee is concerned about the marked decline in routine childhood and adolescent vaccines as a result of the pandemic. The Committee urges CDC to engage providers, health care stakeholders, educators, community organizations, and parents/guardians about the importance of ensuring that children and adolescents visit their primary care provider and receive their routinely recommended vaccinations, including HPV vaccination. In addition, the Committee urges that immunization reminder recall is prioritized. The Committee requests a report within 90 days of enactment of this Act regarding the strategy and plan for the public awareness campaign to increase childhood and adult routine vaccination rates and reduce barriers to routine vaccinations including, but not limited to vaccine hesitancy. This report should include information on immunization rates of all age groups and provide disaggregated data on vaccines rates to determine disparities across race, ethnicity, sex, age, and zip code, as available, for both routine and COVID–19 vaccinations. In addition, the report shall address actions taken and plans to strengthen awareness, understanding, and trust in vaccines (pg. 80).

  • Improving Immunization Information System Infrastructure and Data.—The Committee is concerned about the state of interoperability across Immunization Information Systems (IIS), especially as vaccine administration information becomes more critical with respect to stopping the COVID–19 pandemic. It is important that IIS across the country interoperate with each other, are capable of transmitting information to public health authorities, including CDC, and that each IIS has the capacity to intake data and satisfy bidirectional queries. The Committee includes $5,000,000 for CDC to consult with stakeholders to outline the steps toward a more robust common core data set for collection of vaccine administration information and to initiate a national framework that includes the minimum functional standards for IIS to interoperate (pg. 80).

  • Influenza Planning and Response.—The Committee includes an increase of $25,000,000 to enhance CDC’s influenza activities, including expanding vaccine effectiveness monitoring and evaluation, and increasing influenza vaccine acceptance by removing barriers to vaccination and promoting vaccination coverage (pg. 80).

  • Influenza Vaccine.—The Committee encourages CDC to consider including vaccines produced through recombinant DNA technology in addition to traditionally-produced vaccines in future solicitations to facilitate the competitive process for all vaccine manufacturers (pg. 80).

  • Respiratory Syncytial Virus.—The Committee applauds the ongoing development of novel immunizations to provide protection for all infants against Respiratory Syncytial Virus (RSV) disease. Currently, there is no licensed immunization that can protect all infants from RSV. The Committee encourages CDC and the Advisory Committee on Immunization Practices (ACIP) to review any novel immunization, including monoclonal antibodies, that holds the promise of broad protection for all infants and public health benefit to children, for inclusion on the Child and Adolescent Immunization Schedule and in the Vaccines for Children program (pg. 81).

  • Shared Clinical Decision Making.—The Committee encourages CDC to work with health professional organizations to utilize decision making support tools to promote recent changes made to the Evaluation and Management office visit Current Procedural Terminology codes which allow for the use of ‘‘Total Time’’ or the use of ‘‘Medical Decision Making’’ as key contributing factors, for the basis of payment for vaccination counseling and administration. This will ensure that medical professionals and patients are informed and have a clear understanding of and continued access to the immunizations they should receive across the life course (pg. 81).

  • Vulnerable Populations.—The Committee commends the CDC ACIP recommendations and the Office of Civil Rights for its continued vigilance regarding potential discrimination in vulnerable populations during the COVID–19 pandemic and for working collaboratively with States to ensure State guidelines reflect best practices for serving individuals with disabilities and the elderly (pg. 81).

 

Other notable investments in the nation’s immunization capacity and infrastructure include:

  • $5 million for CDC to consult with stakeholders to outline the steps toward a more robust common core data set for collection of vaccine administration information and to initiate a national framework that includes the minimum functional standards for Immunization Information Systems to interoperate.

  • an increase of $25 million to enhance CDC’s influenza activities, including expanding vaccine effectiveness monitoring and evaluation and increasing influenza vaccine acceptance by removing barriers to vaccination and promoting vaccination coverage.

  • a $1 billion flexible funding stream to bolster public health infrastructure.

  • an increase of $50 million to develop the country’s public health workforce.

  • an increase of $100 million to support public health data modernization efforts.

  • level funding for the Preventive Health and Health Services Block Grant Program at $160 million.

  • $943 million for the Prevention and Public Health Fund, an increase of $87 million (10 percent) above the FY21 enacted level and $40 million above the President’s budget request.

 

The text of the FY22 House Labor-HHS bill can be found here, and the bill report can be found here.

PRESIDENT'S BUDGET REQUEST

CDC REPORT
TO CONGRESS

SENATE APPROPRIATIONS BILL

CONFERENCE BILL