SENATE APPROPRIATIONS BILL

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On October 18, the Senate Appropriations Committee released the fiscal year 2022 (FY22) Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) appropriations bill. The legislation includes $9.73 billion for the Centers for Disease Control and Prevention (CDC), an increase of over $1.85 billion (24 percent) above the FY21 enacted funding level. The appropriation, though $837 million lower than the increase included in the House Labor-HHS bill, constitutes the largest proposed funding increase for CDC in two decades.

 

The bill contains a substantial funding boost for the CDC’s Section 317 Immunization Program. The legislation appropriates just under $713.6 million to the program, an increase of more than $99.9 million (16 percent) over the FY21 enacted funding level. The funding amount is $5 million less than the increase included in the House version of the bill. In addition to the robust funding increase, the bill report includes the following language relevant to the 317 program:

 

  • 317 Immunization Program.— The Committee recognizes that the COVID–19 pandemic has exposed critical gaps in our nation’s immunization infrastructure resulting from years of stagnant funding. The Committee includes an increase of $99,925,000, consistent with the budget request, to enhance adult immunization and directs CDC to increase base awards. The Committee expects this funding to promote health equity related to protection from vaccine-preventable diseases as well as address vaccine hesitancy. Additionally the Committee looks forward to reviewing the fiscal year 2023 report on estimated funding needs of the Section 317 Immunization Program and requests that the report be updated and submitted no 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 evolving role of the 317 program as expanded coverage for vaccination becomes available from private and public sources and continues to change. The Committee also requests that the report 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 flu. The Committee encourages CDC to leverage the Data Modernization Initiative for its Immunization Information Systems (pg. 76-77).

  • 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 remains critical to ending the COVID–19 pandemic, as well as preventing and responding to future public health emergencies. There is wide variability in the implementation of IIS across the United States. CDC and the public health community require consistent data on vaccine distribution and administration, including the collection of demographic data (e.g., race/ethnicity) in order to assess vaccination coverage and track doses administered, identify disparities and gaps in uptake among various populations, and prevent future outbreaks. The Committee recognizes that CDC has developed a national standard for sharing immunization data and a recommended minimum set of data elements and that improvements made through the CDC Data Modernization Initiative [DMI] are benefiting programs, including immunization, across CDC. The Committee encourages CDC to continue to leverage gains made through DMI and work with jurisdictions to promote the adoption and adherence to national standards to support the capture of data for all vaccinations administered across the life course. (pg. 77).

  • Improving Immunization Rates and Vaccine Confidence.— The Committee is concerned by recent decreases in pediatric and adult routine vaccination due to the COVID–19 pandemic, vaccine hesitancy, misinformation and disinformation. Data indicate that underserved populations are affected to a greater degree. If not addressed, this trend could expose all Americans, but especially these communities, to vaccine-preventable diseases and exacerbate existing disparities in care. The Committee urges CDC to engage immunization providers, healthcare stakeholders, educators, parents/ guardians and local organizations within these communities to encourage individuals and families to visit their trusted healthcare provider to ensure that children, adolescents and adults receive their routinely recommended vaccinations. Immunization reminder recall should be prioritized among all groups, but especially these communities. The Committee requests an update on CDC’s ongoing ‘‘Vaccinate with Confidence’’ campaign activities and outcomes, and its strategy and plan for the public awareness campaign to increase childhood and adult routine vaccination rates and reduce barriers 78 to routine vaccinations, including but not limited to vaccine hesitancy, no later than 90 days after enactment of this act. This report should include, to the extent practical, information on immunization rates of all age groups and provide disaggregated data on vaccine 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. 77-78).

  • Increasing Adult Hepatitis B Vaccination.— Given that hepatitis B is preventable through a safe and effective vaccine, the Committee is concerned that fewer than one third of adults age 19 and older are vaccinated. These low rates of vaccine coverage among adults represent a missed opportunity to prevent hepatitis B infection and highlight the need to increase hepatitis B vaccination among adults. The Committee urges CDC to redouble its efforts to address this long-standing problem. The hepatitis B vaccine has been described as the first ‘‘anti-cancer’’ vaccine, since preventing hepatitis B virus infections prevents primary liver cancer. The Committee understands the CDC Advisory Committee on Immunization Practices will be reviewing evidence for a universal adult hepatitis B vaccination recommendation and looks forward to its implementation. The Committee urges CDC to develop a plan to achieve adult hepatitis B vaccination goals (pg. 78). 

  • 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, enhancing virus characterization, increasing genomic testing of influenza viruses, and increasing influenza vaccine uptake by eliminating barriers to vaccination and enhancing education and communication efforts toward key communities (pg. 78). 

  • Shared Clinical Decision Making.— The Committee recognizes that the concept of shared clinical decision making is not new in healthcare but has yet to be well defined and the long-term impact on access to vaccines understood. While greater involvement by patients in their care is to be encouraged, physicians, other providers, and public and commercial insurance plans need clarity about how to reconcile this category of recommendation with the long-established ‘‘strong recommendation’’ for vaccination. The Committee encourages CDC to work with health professional organizations to promote recent changes made to the Evaluation and Management office visit Current Procedural Terminology codes, which help provide the basis of payment for vaccination counseling and administration. This will help ensure that medical professionals and patients are informed and have a clear understanding of the immunizations they should receive across the life course (pg. 78).

 

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

  • 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 $600 million 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 Senate Labor-HHS bill can be found here, and the bill report can be found here.

PRESIDENT'S BUDGET REQUEST

CDC REPORT
TO CONGRESS

HOUSE APPROPRIATIONS BILL

CONFERENCE BILL