Priorities for the National Vaccine Plan (2010) / Chapter Skim
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. This report, Priorities for the National Vaccine Plan, aims to identify a set of actions the committee believes merit primary attention as NVPO and its partners finalize and implement the National Vaccine Plan.
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The contemporary national vaccine program3 is extraordinarily complex in all aspects, from research and development of new vaccines to financing and reimbursement of immunization services. As a medical product, preventive vaccines occupy a unique niche because they are given to healthy individuals, they are purchased in large volume by the federal government as part of the Vaccines for Children entitlement program, and government public health agencies at the federal and state level make policy decisions about how best to use vaccines to protect the public's health.
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Coordinating governmental and non-governmental activities 9. Funding of federal agencies Although the National Vaccine Program has had some great successes and there have been examples of effective coordination, neither NVPO (whose stated work is to provide "leadership and coordination among Federal agencies, as they work together to carry out the goals of the National Vaccine Plan")
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It is understandable why the plan's drafters chose to include both activities that are part of existing strategic plans and are certain to be accomplished in the near future, and activities that are novel, not necessarily represented in any other planning document, and require multi-sectoral coordination and collaboration. However, the committee suggests that NVPO consider distinguishing between objectives or strategies that are likely to be accomplished regardless of their placement in the National Vaccine Plan and those that are unique to the plan and require coordination among agencies and with non-government stakeholders in order to be achieved.6 The committee's recommendations about "priority areas within major components of the plan" refer to the latter type of objectives and strategies.
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Recommendation 6-1: The Secretary of HHS should actively dem onstrate the Department's support for the National Vaccine Plan by: (1) clarifying its primacy as the strategic planning tool ap plicable to all federal agencies with roles in the National Vaccine Program, and (2)
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Recommendation 1-1: The National Vaccine Plan should incor porate improvements in the vaccine regulatory process that reflect current science and encourage innovation without compromising efficacy and safety. Improvements include: • Strengthening communication with vaccine developers through more frequent workshops and guidance documents.
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Furthermore, some examples of innovative and productive intersectoral collaboration come from a history of public-private partnerships, from the World War II era collaborations between the Department of Defense, industry, and academia, to contemporary development of vaccines for global health through product development partnerships. Recommendation 1-3: The National Vaccine Plan should incor porate creation of a strategy for accelerating development of high priority vaccines that (a)
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that collects vaccine safety data, generates hypotheses, and conducts studies to evaluate safety hypotheses. Recommendation 2-1: The National Vaccine Plan should establish a process to identify potential vaccine safety hypotheses for further basic, clinical, or epidemiologic research through annual review of data from the Vaccine Adverse Event Reporting System (VAERS)
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Recommendation 2-2: The National Vaccine Plan should emphasize the development and publication of a framework for prioritizing a national vaccine safety research agenda that spans all federal agen cies and includes all stakeholders, including the public. The scientific criteria of such a framework for prioritization might include, but are not limited to: (a)
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For example, neurologists could be convened to discuss the biological mechanisms of a given neurological event, and epidemiologists could discuss studies VSD could undertake. Recommendation 2-4: The National Vaccine Plan should incor porate concrete steps to expand and strengthen vaccine safety research, including: • enhanced funding for CDC's Immunization Safety Office activities, including support of extramural research; • enhanced funding for FDA's safety monitoring activities; and • expansion of NIH vaccine safety activities to include re search portfolios, funding through requests for proposals, program announcements, and creation of a study section dedicated to vac cine safety research.
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The committee also finds that there is no coherent effort to apply existing communication science to shape a research agenda that could inform the national vaccine communication strategy. Recommendation 3-2: The National Vaccine Plan should incorpo rate a process for identifying research needs to inform the national communication strategy, including research on how the public ob tains information about vaccines and immunization, perceives risks, and makes decisions concerning vaccination in the contemporary information environment.
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Recommendation 4-1: The national Vaccine plan should include the development and implementation of strategies to assure a stable and adequate vaccine supply for public health preparedness and recommended routine use purposes. A gap in the draft Goal 4 is the lack of objectives or strategies linking health care financing with health services performance measures to induce and enable providers to seek out, stock, and administer ACIP-recommended vaccines.
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Recommendation 4-5: Given the importance placed on the national adoption of certified, interoperable health information technology and electronic health records, the National Vaccine Plan should ensure active involvement of NVPO and relevant partners in the planning and implementation of the national health information initiative. This involvement should include: • Assuring the development and adoption of standards necessary for effective immunization clinical practice and population surveillance systems; • Assuring that the definition of "meaningful use" considers immunization practice and reporting; • Facilitating use of vaccine-related data by all public health partners (e.g., state and local public health departments)
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Recommendation 4-7: The National Vaccine Plan should incorpo rate rapid and comprehensive assessment of the outcomes of na tional health reform and their implications for the nation's vaccine and immunization priorities. Specifically, NVPO, as "owner" of the plan, could contribute by: • Participating in implementation efforts related to the expanded health insurance access for the population.
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. Draft Strategic National Vaccine Plan.
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. The National Vaccine Plan Process -- Update.
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