On July 28, the Senate Appropriations Committee released the fiscal year 2023 (FY23) Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) appropriations bill. The legislation includes just over $10.5 billion for the Centers for Disease Control and Prevention (CDC), an increase of over $2 billion (24 percent) above the FY22 enacted funding level.

 

The bill contains a substantial funding boost for the CDC’s Section 317 Immunization Program. The legislation appropriates an increase of nearly $210 million (32 percent) to the program for a total of almost $860.8 million. The funding will be used to enhance the adult immunization infrastructure to increase routine vaccination rates, detect and respond to outbreaks of vaccine-preventable disease, and address vaccine hesitancy as well as support surveillance and laboratory efforts to promote human papillomavirus (HPV) vaccination. Also included is $25 million for the CDC to study long-COVID conditions. In addition to the robust funding increase, 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 rates to prevent the spread of disease, disability, and death from vaccine-preventable diseases [VPDs]. The Committee includes an increase of $209,975,000 to enhance immunization efforts and directs CDC to increase base awards. The Committee expects this funding to promote health equity related to protection from 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. The total includes $25,000,000 for CDC to continue activities for studying long-COVID conditions to identify symptoms, risk factors, demographic groups disproportionately impacted, prevalence, and treatments. The total also includes $5,000,000 for CDC to improve HPV vaccination coverage through programs that increase awareness, education, and training on HPV vaccination for cancer prevention. (pg. 72)

• Advisory Committee on Immunization Practices [ACIP] Process.— The Committee recognizes the important work of ACIP in regularly evaluating vaccines, particularly in light of the pandemic. Given the importance of maintaining the timely review of vaccines and best practice guidelines, the Committee requests information from CDC on what ACIP needs to ensure timely access to immunizations. Specifically, CDC is directed to provide a report outlining the level of resources necessary to support both routine and emergency reviews in real time. The report should indicate what is needed around implementation, including CDC’s continued ability to communicate and coordinate with providers and partners. (pg. 72)

• 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, 2023 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. (pg. 72)

• Immunization Information Systems [IIS].—There are over 60 different immunization data systems across the U.S. resulting in wide variability in technical and programmatic capacity, as well as fragmented vaccination data. It is important to ensure 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 encourages CDC to ensure that all IIS adopt and adhere to consistent standards to support the private and secure capture of data for all vaccinations administered across the life course, and have secure information sharing capabilities both inter and intra State and with other IIS, health information exchanges, health data systems and entities, including data repositories to achieve interoperability levels needed to capture all vaccine administration data. (pg. 73)

• Immunization Data Optimization.—The Committee is aware that some States that receive resources to support 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 ONC, work with States to develop a plan to encourage all providers who vaccinate to report immunization data across the life course. (pg. 73)

• Increasing Adult Hepatitis B Vaccination.—The Committee urges CDC to promote hepatitis B vaccination among all adults ages 19 through 59. Funding has been provided to ensure timely implementation of the ACIP recommendation in fiscal year 2023. The Committee urges CDC to provide leadership to ensure the new 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 what challenges and barriers currently exist to access that are limiting vaccination rates and preventing vaccine series completion required to achieve full immunity. (pg. 73)

• Influenza Planning and Response.—The Committee includes an increase of $40,000,000 to enhance CDC’s influenza surveillance and preparedness 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 with key communities. (pg. 73)

• Promoting Routine Vaccination.—The Committee is concerned by recent declines in routine vaccination across the life course due to the COVID–19 pandemic, with underserved populations affected to a greater degree. If not addressed, these trends will expose Americans to VPDs, outbreaks, and exacerbate existing disparities in care. The Committee encourages CDC to promote HPV vaccination in support of the Administration’s Cancer Moonshot Initiative. 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 individuals visit their primary care provider and receive their routinely recommended vaccinations. The Committee also requests CDC provide the Committees on Appropriations an update on the achievements of the ongoing ‘‘Vaccinate with Confidence’’ campaign and the rate of routine vaccination across all ages, as well as a forward-looking plan to administer missed doses. CDC should include in the plan recommendations about what other tools it could employ to address this health equity issue. (pg. 73-74)

 

 

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

• an increase of $40 million to enhance CDC’s influenza activities, including expanding vaccine effectiveness monitoring and evaluation and 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 with key communities.

• a $600 million flexible funding stream to bolster public health infrastructure.

• 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.

 

The text of the FY23 Senate Labor-HHS bill can be found here, and the bill report can be found here.