WASHINGTON -- While vaccines help prevent many diseases in the United States, we lack immunization protection against several serious illnesses, says a new report from the Institute of Medicine that identifies priority areas for updating the National Vaccine Plan. The revised plan should include a strategy to accelerate development of high-priority vaccines, said the committee that wrote the report. In addition, it should emphasize the importance of expanding funding for safety research and monitoring, and include the development of a national communications strategy to clarify the importance of vaccines and bolster public confidence in the immunization system.
The National Vaccine Plan aims to provide centralized coordination of the various components involved in protecting Americans from vaccine-preventable illnesses and vaccine-related adverse reactions. The immunization system engages many partners -- including multiple government agencies and departments, vaccine researchers, manufacturers, public health officials, health care providers, and the public -- in identifying vaccine needs, researching and developing new products, assessing safety, and getting people immunized. The U.S. Department of Health and Human Services (HHS) released a draft update to the plan in 2008 and requested that IOM conduct an independent assessment of issues that merit priority attention.
The updated plan should call for a greater proportion of vaccine research and development to be directed at specific goals, such as producing vaccines against diseases for which there are none or developing a single vaccine that would work against all influenza viruses, the committee said. The majority of vaccine research and development stems from the focus and interests of individual researchers rather than a set of priority targets identified through a centralized planning process.
Given the absence of a framework to set a national vaccine-safety research agenda, the National Vaccine Plan should call for expanded funding for safety research and include establishing a permanent group to advise the government on safety issues, the report says. Little vaccine research supported by the National Institutes of Health appears to be geared toward safety, the committee noted. Moreover, as the number and kinds of vaccines have increased, funding to monitor safety has not. The monitoring system has successfully caught problems such as a rare but severe intestinal injury linked to a discontinued rotavirus vaccine, but the Immunization Safety Office within the Centers for Disease Control and Prevention needs more resources to do its work. A new vaccine safety advisory group could guide efforts to address potential safety concerns and the development of a research agenda with clear priorities.
Noting that a proliferation of misinformation about vaccines' effectiveness and safety has contributed to diminished public understanding of and confidence in the value of immunization, the committee called for the National Vaccine Plan to include the development of a national communications strategy that engages the latest techniques and methods, such as social networking. Outreach efforts by federal agencies and other public health groups have been disjointed and reactive and not as effective as they should be, the committee said. The effort should boost health care providers' abilities to talk about the benefits and risks of vaccines with patients as well as increase the public's understanding of vaccines.
The National Vaccine Plan should also include a strategy to eliminate financial barriers to immunization, such as lack of health plan coverage for all recommended vaccines and insufficient reimbursements that do not cover all of a clinic's costs of providing vaccines, the report added. Certain subgroups, such as the elderly and people with lower incomes, tend to have greater difficulty getting the vaccines they need. The plan also should promote the use of health information technology to monitor disease incidence, rapidly detect potential safety signals, and measure vaccine coverage. Tracking patients' immunization status should be an integral part of electronic health records, the report says.
The National Vaccine Program Office (NVPO), which Congress intended to coordinate vaccine activities across government agencies, requires a heightened profile and more resources to carry out its role and to implement the National Vaccine Plan, the committee said. The HHS secretary should clarify NVPO's role as the central coordinator for critical immunization activities and give it the necessary funding to fulfill this role.
"Coordination is at the heart of the National Vaccine Plan, and it needs to be strengthened," said committee chair Claire V. Broome, adjunct professor, department of global health, Rollins School of Public Health, Emory University, Atlanta. "While the immunization system has functioned well through the years, we may have missed opportunities, for example, to expand our use of cutting edge vaccine science or to use new communication methods to get accurate information on vaccines to the public. The National Vaccine Plan and the National Vaccine Program Office can provide the central coordination needed, given sufficient resources and support from HHS."
The study was sponsored by the U.S. Department of Health and Human Services. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. A committee roster follows.
Pre-publication copies of PRIORITIES FOR THE NATIONAL VACCINE PLAN are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at HTTP://WWW.NAP.EDU. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).
[ This news release and report are available at HTTP://NATIONAL-ACADEMIES.ORG ]
INSTITUTE OF MEDICINE
Board on Population Health and Public Health Practice
COMMITTEE ON REVIEW OF PRIORITIES IN THE NATIONAL VACCINE PLAN
CLAIRE V. BROOME, M.D. (CHAIR)
Adjunct Professor
Department of Global Health
Rollins School of Public Health
Emory University
Atlanta
ELAINE CHATIGNY
Director General of Communications
Public Health Agency of Canada
Communications Directorate
Ottawa
JOCELYN GUYER, M.P.A.
Co-Executive Director
Center for Children and Families, and
Senior Researcher
Health Policy Institute
Georgetown University
Washington, D.C.
TIMOTHY J. HOFF, PH.D.
Associate Professor of Health Policy and Management
Department of Health Policy, Management, and Behavior
State University of New York
Albany
GRACE M. LEE, M.D., M.P.H.
Assistant Professor of Pediatrics
Division of Infectious Diseases
Departments of Medicine and Laboratory Medicine
Children's Hospital Boston, and
Assistant Professor of Population Medicine
Harvard Medical School
Harvard Pilgrim Medical Care Institute
Boston
RICHARD MANDSAGER, M.D.
Chief Executive
Providence Alaska Medical Center
Anchorage, Alaska
EDGAR K. MARCUSE, M.D., M.P.H.
Professor of Pediatrics
School of Medicine, and
Adjunct Professor of Epidemiology
School of Public Health
University of Washington; and
Associate Medical Director for Quality Improvement
Seattle Children's Hospital
Seattle
A. DAVID PALTIEL, PH.D.
Professor and Acting Head
Division of Health Policy and Administration
Yale School of Medicine
New Haven, Conn.
ARTHUR L. REINGOLD, M.D.
Edward Penhoet Distinguished Professor of Global Health and Infectious Disease, and
Associated Dean for Research
School of Public Health
University of California
Berkeley
DAVID B. REUBEN, M.D.
Director
Multicampus Program in Geriatrics Medicine and Gerontology, and
Archstone Professor of Medicine and Chief
Division of Geriatrics
David Geffen School of Medicine
University of California
Los Angeles
SARA ROSENBAUM, J.D.
Chair
Department of Health Policy, and
Harold and Jane Hirsh Professor of Health Law and Policy
School of Public Health and Health Services
George Washington University
Washington, D.C.
MILAGRITOS D. TAPIA, M.D.
Assistant Professor of Pediatrics and Medicine
Pediatric Infectious Diseases
University of Maryland
Baltimore
INSTITUTE OF MEDICINE STAFF
ALINA BACIU, M.P.H.
Study Director