On July 27, the Senate Appropriations Committee released the fiscal year 2024 (FY24) Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) appropriations bill. The legislation includes $9.2 billion for the Centers for Disease Control and Prevention (CDC) and level funds the CDC Section 317 Immunization Program at $681,933,000.

 

The report includes the following language relevant to the 317 Program:

 

• 317 Immunization Program.—The Committee recognizes CDC’s immunization program plays a fundamental role in achieving national immunization goals and sustaining high vaccination coverage. In addition, this program underpins the protection of all children being vaccinated, even those fully insured, by providing Federal, State and local resources to investigate outbreaks, conduct surveillance, and provide public awareness campaigns to address vaccine hesitancy that continues to be the root cause of outbreaks for measles and other preventable diseases. The Committee continues to expect funding be used to promote health equity related to protection from vaccine preventable diseases [VPDs] as well as address vaccine hesitancy. CDC is directed to expand the existing immunization infrastructure, including implementing new strategies for hard-to-reach populations, such as those who may be vaccine- hesitant, those who are members of racial and ethnic or other minority groups, and those who are underserved due to socioeconomic or other reasons.

 

• Advisory Committee on Immunization Practices [ACIP] Process.— The Committee recognizes the important work of ACIP in regularly evaluating and providing informed vaccine recommendations. Following an ACIP recommendation that the CDC Director has reviewed and approved, timely publication in the CDC Morbidity and Mortality Weekly Report [MMWR] is critical to ensuring health insurance coverage and timely provider implementation. Given the importance of the review, recommendation, and publication process, the Committee requests that CDC provide a report to the Committee outlining the resources necessary to support both routine and emergency reviews in real time as well as timely MMWR publication of recommendations to ensure appropriate patient access. The report should include recommendations for changes necessary to improve efficiency in the ACIP process that will result in expedited communication of recommendations.

 

• Cost Estimates.—The Committee requests that the report on estimated funding needs of the Section 317 Immunization Program be updated and submitted not later than February 1, 2024, to the Committees on Appropriations. 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 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 HPV and influenza. The Committee directs CDC to provide a professional judgment budget estimate to the Committee that specifically outlines the cost to fully fund an uninsured adult immunization program that includes the cost of purchase, storage, and administration of all ACIP-recommended adult vaccines and allows for provider choice of product, outreach, and counseling grants to providers and community-based organizations.

 

• Immunization Data Optimization.—The Committee is aware that some States that receive resources to support Immunization Information Systems [IIS] allow providers to opt-into transmitting vaccination data for some populations to the IIS. The Committee is concerned that this could lead to gaps in data and potential outbreaks in VPDs. The Committee requests CDC, along with the Office of the National Coordinator for Health Information Technology [ONC], work with States to develop a plan to encourage all providers who vaccinate to report immunization data across the life course.

 

• Increasing Adult Hepatitis B Vaccination.—The Committee urges CDC to promote hepatitis B vaccination among all adults ages 19 through 59 as recommended by ACIP. The Committee urges CDC to provide leadership to ensure the recommendation is implemented, and to coordinate implementation activities with the HHS Assistant Secretary for Health and HRSA and engage providers and community-based organizations as necessary. The Committee requests a report to Congress on current challenges and barriers to access that are limiting vaccination rates and preventing vaccine series completion required to achieve full immunity.

 

• Long COVID.—The Committee encourages CDC to monitor and track incidence of Long COVID among children and adults, including developing a patient registry for Long COVID.

 

• Promoting Routine Vaccination.—The Committee is concerned by the continued lag in routine vaccination across the life course due to the COVID–19 pandemic, with underserved populations affected to a greater degree and adolescents affected disproportionately. If not addressed, these trends will increasingly expose Americans to VPDs, outbreaks, and exacerbate existing disparities in care. The Committee urges CDC to prioritize and to allocate resources to engage providers, healthcare stakeholders, educators, community organizations, and families on the importance of ensuring that all receive routinely recommended vaccinations, ensuring that resources are allocated to address disparities in vaccination rates based on race/ethnicity and age. Within 60 days of the enactment, CDC shall provide the Committee with an update on the ongoing ‘‘Vaccinate with Confidence’’ campaign and the rate of routine vaccination across all ages, as well as an update on the forward-looking plan to administer missed doses. CDC should include updated recommendations about what other tools it could employ to address this health equity issue.

 

• Protecting Immunization Data.—The Committee encourages CDC to continue its work with State and local health departments and affiliated partner organizations toward adoption of and adherence to nationally accepted privacy and security standards for immunization data captured across the life course that includes bi-directional data reporting between public health authorities and providers at the point of care. The Committee further asks CDC to provide an update on the status of immunization work to date in the context of the CDC data modernization initiative in the fiscal year 2025 CJ.

 

 

Other funding related to immunization capacity and infrastructure includes:

• level funding at just over $231 million for CDC’s Influenza Planning and Response program.

• $160 million for Public Health Data Modernization efforts, a decrease of $15 million.

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

 

The text of the FY24 Senate Labor-HHS bill text can be found here, and the bill report can be found here.