October 2007 NVAC Meeting Minutes
They have put out a 2007 immunization recognition program, which looks at immunization strategies in various health plans.
CDC’s Vaccine Stockpile Plan—Dr. Gregory S. Wallace
Dr. Gregory S. Wallace began his presentation with a brief history of the vaccine stockpile. In 1983, 317 funding was used to purchase stockpile vaccine for diphtheria, tetanus, pertussis, polio, and measles containing vaccines. Currently, MMR and IPV vaccines are all that are left as part of the 317 stockpile funding. In 1993, VFC legislation was passed, which required a 6-month stockpile. There are currently more than 20 million doses of vaccine in the CDC stockpile. However, no funding has been obligated for the vaccine stockpile at this time.
Dr. Wallace then turned the focus of the presentation to the VFC stockpile legislation. One of the principles of the legislation is that there should be an adequate supply of pediatric vaccines to meet unanticipated needs. He explained that it is difficult to anticipate unanticipated needs. The legislation also states that CDC should negotiate for a 6-month supply and should consider the potential for outbreaks. With the exception of the remaining MMR and IPV vaccine, the rest of the vaccine in the stockpile is VFC funded.
Dr. Wallace then looked at the vaccines for which CDC experienced supply issues since 2000. Most of the supply issues ended up lasting more than a year. MMR was the only vaccine for which there was actually stockpile to use when the shortage occurred. The rest of the vaccine shortages required that interim changes be made in the recommendations for vaccination.
Dr. Wallace then discussed challenges with negotiating a 6-month stockpile. Challenges lie in that the market changes, for example, with the introduction of combination vaccines and that recommendations change as well, for example, with the addition of the second dose of varicella vaccine. In order to keep vaccine in the stockpile fresh, manufactures store and rotate their vaccine supply.
It is also important to consider the potential for outbreaks and to understand that the goal for outbreaks is different from the goal for production interruptions. He explained that combination vaccines may complicate outbreak response. For example, we would not want to use Pediarix during a polio outbreak. He also mentioned the need to consider whether to include vaccines that have low outbreak potential.
Dr. Wallace explained that because the stockpile is VFC funded, it may limit the flexibility of the use of vaccine. He also mentioned the need to minimize the risk of throwing away vaccine or of financial loss and maximizing the stockpile’s utility so that it meets public health needs.
There is now a CDC working group assigned to look at some of these issues as the vaccination schedule and market get more complicated.
Dr. Wallace concluded his presentation by expressing his proposed role for NVAC in this process, which includes the following:
Acting as a sounding board for difficult options;
Discussing options and approaches;
Presenting recommendations for external review (not as clearance but as an interested third party); and
Providing updates when major changes are considered.