Vaccine programs are threatened by exemptions, ACA repeal

My grandfather died in his 40s from an influenza-related illness. My aunt contracted polio, which left her with a permanent limp and other chronic health problems. Thanks to vaccines, these two illnesses and others like them are no longer the huge threats to public and personal health that they once were.

The benefits of effective vaccines are staggering. Each year in the United States, vaccinating babies with the routine immunization schedule saves 33,000 lives and prevents 14 million cases of disease. It reduces direct health care costs by $9.9 billion and indirect costs by $33.4 billion.

Quite simply, vaccines are the safest and most effective way to prevent many diseases. Take, for example, a single U.S. Centers for Disease Control and Prevention (CDC) vaccine effort, the Vaccines for Children Program, which was launched in 1994 in response to a large measles outbreak. Between its launch and 2013, the program prevented an estimated 322 million illnesses, 21 million hospitalizations, and 732,000 deaths, at a net savings of $1.38 trillion in societal costs.

These represent astronomical savings for a health care system that otherwise hasn’t been all that successful in saving the nation money — either by keeping people healthy or reducing costs.

Somehow, though, skeptics continue to challenge the use of vaccines, which has helped erode their use. Last year, more than 2 million preschoolers, 35 percent of seniors, and a majority of adults did not receive all recommended vaccinations. There’s a heart-wrenching cost to this — in the US, an estimated 1,000 children and 45,000 adults needlessly die every year from vaccine-preventable diseases.

There are two root causes for declining vaccination rates: the dangerous proliferation of vaccine exemptions and a lack of adequate support and funding. According to the CDC, nonmedical exemptions — which let children skip a vaccine and still attend school if a parent has a personal objection against vaccines — increased markedly during the 2013-2014 school year, and 80,000 kindergarteners started school without a single vaccine. Young children are among the most vulnerable to vaccine-preventable illnesses. When children don’t get vaccinated, members of the larger community can also suffer: unvaccinated children can spread disease to other children and adults.

The health and education sectors are already working together to ensure that children get the vaccinations they need. But more must be done to limit vaccine exemptions. States should enact and enable universal childhood vaccination except where immunization is medically contraindicated. In addition, states with personal belief exemptions should re-examine those policies so exemptions are available only after appropriate parent education and acknowledgement of risks.

Our highly successful vaccination programs will be in danger if they are not factored into the current discussion of the repeal of the Affordable Care Act (ACA). There’s a clear connection between having health insurance and getting vaccinated, so reducing the number of people with health insurance, which could likely happen if the ACA is repealed, will translate into fewer children and adults who get their recommended vaccines.

Repealing the ACA could also jeopardize direct funding for the CDC’s vaccine programs. The Prevention and Public Health Fund, which was created by the ACA, provides nearly 12 percent of the CDC’s budget. The fund also provides support for what is known as the Section 317 immunization program. It helps ensure that the right vaccines get to the right people at the right time to protect their health, their family’s health, and the health of their communities. If the fund is discarded along with the ACA, the nation would lose nearly $325 million in immunization investments — more than half of the current investment — and states would bear the brunt of those costs and the ensuing health care and societal costs.

The program recently helped California respond to the state’s measles outbreak by supplying nearly 5,000 doses of vaccines. If repealed, California would lose more than $7 million for vaccine programs, and future outbreaks would likely spiral out of control.

In fact, every state would lose vital vaccine funding. Georgia, for instance, would lose more than $6 million, Tennessee would lose $3.7 million, and West Virginia would lose $2.2 million.

The ACA also mandated that all vaccines that are recommended by the Advisory Committee on Immunization Practices be covered with no copayments or cost sharing when provided by in-network providers in group and individual private health plans and for the Medicaid expansion population. This, too, is a valuable policy that should not be overlooked in the current ACA discussions in Congress.

The science on the effectiveness of vaccines is clear. So are lessons from history — older Americans still remember the crippling fright of polio and deadly influenza epidemics. To avoid a return to those tragedies, we must support our nation’s vaccine programs.

This shouldn’t be a partisan issue. Everyone wants to save lives and prevent unnecessary suffering. Time and research have shown that vaccines are one of the most effective and safest ways to do this.

John Auerbach, is president and CEO of Trust for America’s Health and the former associate director for policy at the Centers for Disease Control and Prevention and commissioner of public health for the Commonwealth of Massachusetts.