A study published this month by researchers from
the Centers for Disease Control and Prevention found that most children
who died from the flu were not vaccinated and that 65 percent of these deaths
could have been prevented if all children received the recommended
influenza vaccination. This study adds to the substantial literature
base confirming that vaccines save lives.
President Donald Trump is correct in wanting to
ensure that vaccines, arguably public health's greatest tool to prevent
disease, are also safe for Americans. Unfortunately, his befriending of
vaccine skeptics and his consideration of a new vaccine safety
commission, which would duplicate existing governmental structures, are
not effective approaches. Alternatively, Congress and the administration
could take three steps to support vaccine safety.
Congress should support increased budgets at the National Institutes of Health and CDC for vaccine safety research. The vaccine safety budget
at the CDC is an estimated $20 million compared with its vaccine
procurement and program budget, which is approximately $4 billion.
The National Vaccine Advisory Committee, an
independent federal advisory committee, has previously provided
recommendations for a vaccine safety research agenda. Where there may be
gaps in our knowledge base with regards to the immunization schedule,
vaccine components and vaccine-related adverse events, U.S. Department
of Health and Human Services officials should determine the best way to
support federal agencies in conducting this research.
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One novel financing mechanism could involve
drawing down on the interest accrued from the Vaccine Injury
Compensation Trust Fund. The fund was created to compensate
vaccine-related injury or death petitions for covered vaccines and is
financed through an excise tax on vaccines recommended by the CDC for
routine administration to children. While paying awards, the fund also
earns annual interest, and one could make a legitimate case that a share
of the annual interest go specifically to supporting vaccine safety
research.
The administration should support, promote
and ensure the coordination of existing vaccine surveillance systems
administered across the U.S. government. These systems include, for
example, the Vaccine Adverse Event Reporting System, which collects and
analyzes reports of adverse events that happen after vaccination and is
jointly managed by the CDC and the Food and Drug Administration.
Scientists monitor this data to identify reported adverse events, which
may need to be studied further.
With respect to the reporting system, anyone can
submit a report including the general public. While the administration
should encourage reporting of adverse events that occur after
vaccination, it should also remind parents and patients that the
occurrence of an adverse event does not prove a vaccine caused the event
and that any concerns should be discussed with their health care
provider.
Complementing the reporting system are more
active surveillance systems such as the Vaccine Safety Datalink, a
collaborative project between CDC and nine integrated health care
organizations which links vaccination data to health outcomes and
initiates vaccine safety studies based on new and emerging data or
science. The administration should ensure that the proliferation of
electronic health records support the efforts of these and other
national surveillance systems in generating real-time safety data.
The administration should deploy the Surgeon
General and officers of the U.S. Public Health Services Commissioned
Corps to regions of the country where immunization rates for
vaccine-preventable diseases have fallen to dangerously low levels.
These are levels below which herd immunity – protection from disease
through the vaccination of those around you – might no longer be
effective.
For example, the CDC estimates that Indiana, Kansas and Colorado have fallen below 90 percent coverage
of measles, mumps and rubella vaccination among children enrolled in
kindergarten. More broadly, there are pockets within states, such as
Texas, where vaccine coverage is slipping below herd immunity levels
even though the entire state may still have high overall coverage.
In these geographic areas, federal public health
officials should partner with local leaders and health care
professionals in first listening to citizens and then communicating
scientific evidence pertaining to vaccine safety and the diseases they
are attempting to prevent. Through public health campaigns aimed to
dispel myths and provide information with empathy, the administration
could help create constructive dialogue between scientists and
individuals with vaccine concerns.
Most Americans know that vaccines play a
critical role in ensuring optimal individual and public health across
the lifespan, from the very young to older adults. Supporting the
important public health role of vaccines while continuing to enhance
vaccine safety should not be mutually exclusive policy goals. The ideas
outlined above could help the administration advance a strategy to
better protect the health and lives of Americans, particularly those who
are most vulnerable and cannot be vaccinated.
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