Yet, vaccines — indeed, public health in general — stand to suffer in the current political climate. As Dr. Offit pointed out in a recent Daily Beast article, “The Trump White House is on the verge of delivering a one-two punch to . . . childhood immunizations.” So, what is the story and how might it affect you?
The one-two punch
The current annual budget and the currently tenuous nature of the Affordable Care Act (ACA) both stand to deal a blow to funding for vaccines and public health:
Current budget — President Trump’s original budget proposed a 17 percent decrease in funding for the Centers for Disease Control and Prevention (CDC). While the House Appropriations Committee’s version would restore some of this proposed decrease, the CDC budget would still suffer an almost $200 million cut.
Affordable Care Act — Even with the recent breakdown of the replacement healthcare bill offered by Republicans, vaccines will suffer if the ACA is repealed. One of the hallmarks of the ACA is a focus on prevention; therefore, as part of the ACA mandate, the Prevention and Public Health Fund (PPHF) was created in 2010. Funds from this program were intended “to provide expanded and sustained national investments in prevention and public health, to improve health outcomes, and to enhance health care quality.” Over time funds directed toward immunizations (as a line item in the federal budget) have decreased while funds provided through the PPHF have increased, providing about half of the immunization-related federal funding sent to states and territories during fiscal year 2016.
So what would this mean for your practice, your community and your family?
Several groups and individuals have pulled together valuable resources to understand in detail how these two situations could affect not only vaccine programs, but also public health. Some of the highlights to consider:
Your practice — These possible changes may affect your practice on a couple of fronts. First, the support you receive from your local or state public health department is likely to suffer. Free vaccines for those who qualify through the Vaccines for Children (VFC) program are likely to remain available. However, staff cuts may result in longer wait times for VFC vaccines to be ordered by the health department and received in offices; more difficulty getting in touch with staff for questions or other support; longer time periods between compliance reviews; and decreases in efficiency maintaining registries. Second, if families lose insurance coverage with the loss of the ACA, or if they now need to pay a copay for vaccines, more families may choose to forego immunizations — or avoid healthcare visits altogether. The result being fewer well visits and, sadly, sicker patients who waited or tried to avoid a healthcare visit during an illness. Also affected will be programs related to tobacco control, HIV prevention, newborn hepatitis B risk, HPV vaccination targeting, and community preparedness, among others. Schools, WIC clinics and other community partners would also feel the effects as reductions in public health affect the aforementioned community wellness programs and support for disease outbreak investigations and vaccination coverage.
Your community — More individuals avoiding healthcare visits and preventive measures, such as vaccines, could lead to increased exposure to and spread of infectious diseases. Further compounding this will be fewer public health personnel to investigate outbreaks, particularly those with years of public health experience. The Association of Immunization Managers estimates that the loss of PPHF funds would mean a “minimum 45 percent cut in program funding” for immunizations. To see how your state has been using PPHF funds, review the state-by-state guide prepared by Democrats from the Senate Health, Education, Labor and Pensions and House Energy and Commerce Committees.
Your family — As herd immunity erodes and healthcare and insurance costs rise, your family may face both health-related and household budget-related changes. For those in public health who lose jobs, the situation will be felt even more personally.
In a nutshell, what is happening in Washington will affect all of us. For more information or to get involved, check out these resources:
Make a difference at the local level by attending council meetings, writing op-eds, meeting with your elected officials, or even running for office. These activities may not directly relate to the above situation, but they will afford you the opportunity to have your voice heard when it comes to local issues.
Materials in this section are updated as new information and vaccines become available. The Vaccine Education Center staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family's personal health. You should not use it to replace any relationship with a physician or other qualified healthcare professional. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult your physician or, in serious cases, seek immediate assistance from emergency personnel.