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Technically Speaking: Celebrating 30 Years of Vaccines for Children

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Technically Speaking: Celebrating 30 Years of Vaccines for Children
November 25, 2024

Editor’s Note: To celebrate 30 years of success of the Vaccines for Children (VFC) program, we want to thank Mary Beth Koslap-Petraco for sharing her memories as one of the first coordinators on the ground supporting the program. We hope you enjoy reading about her experience helping to build the VFC program in the Suffolk County Department of Health Services, where she managed and led the immunization programs.

 

It is hard to believe that the Vaccines for Children (VFC) program is celebrating its 30th birthday this year. In 1994, I was appointed the coordinator for immunizations in the Suffolk County Department of Health Services (SCDHS) in the state of New York. Immunization rates for underserved children in the county were dismal. Shortly after my appointment, I was informed by the state health department that we had received a grant to improve immunization rates in underserved children. The Centers for Disease Control and Prevention (CDC) would be providing vaccines at no charge to providers who enrolled in the VFC program. We quickly became one of the first VFC providers in the state. I was assigned to implement the VFC program in Suffolk County. I am excited to reminisce and share that journey in this issue of “Technically Speaking.” 

The community landscape

In 1994, few pediatric providers in Suffolk County accepted payments from the federal Medicaid program, so SCDHS decided to enroll in the VFC program and go into the community and administer vaccines to children at sites near where they lived. The county-run immunization clinics served as a temporary bandage until we could increase the number of private providers who agreed to see children receiving insurance through Medicaid.            

Enrolling in VFC 

The requirements for enrollment in the VFC program in 1994 were having a refrigerator and freezer compliant with CDC recommendations, including a thermometer and a paper-based recording of temperature trends. Even in those early days, a “Vaccine Storage and Handling Plan” was an essential part of the agreement with the New York State Department of Health (NYSDOH). A vaccine coordinator and backup also had to be named. Details about when the practice was open to receive vaccine deliveries, plans to move the vaccines if there was a power failure, and the make and model of both the refrigerator and freezer had to be included in the information sent to NYSDOH. 

Training

In preparation for the implementation of VFC throughout the state, NYSDOH arranged for two staff members from each of the counties to go to Albany to take the “Pink Book” course (though at that time the textbook was blue!). Dr. Bill Atkinson, Dr. Walt Orenstein and Donna Weaver, RN, spent three days with more than 50 public health nurses teaching us. These CDC staffers were THE developers of the policies and the course on vaccines that was used to implement the VFC program. How lucky we were to get to know and learn from these visionaries! They told us we were going to be “Immunization Nurse Champions,” and we certainly left Albany fired up to get vaccines to children who were so often forgotten.

The paperwork

Some of the administrative tasks of 30 years ago still stand today: Signing provider agreements, verifying VFC eligibility, agreeing to administer all ACIP recommended vaccines, and collecting and submitting data on the number of children vaccinated.

After submitting the paperwork and getting our refrigerator and freezer approved, we were ready to begin. Our community outreach worker had been setting up sites for our immunization clinics in churches and community service agencies. We had 50 children or more showing up everywhere we went. As the beginning of the school year approached, over 100 children showed up at each event! 

Convincing providers 

Now that we had a successful local model, our next challenge was to convince physicians in the community to become VFC providers. We obtained a list of the pediatric providers in Suffolk County and systematically called and made appointments to visit over 300 practices. In these conversations, we covered everything from reviewing paper copies of the practice agreements to what refrigerators and freezers the county used and why we liked them. We showed them the Vaccine Information Statements (VIS) that were required to be shared before vaccines were given, and we talked about the value of generators and how they protected our very precious and valuable vaccines. We talked to the nurses about temperature monitoring and raved about the “Pink Book” course. 

Most importantly, we discussed how well received our vaccine clinics were in the community, assuring the private practice providers that if they enrolled in VFC, parents would be happy to have a medical home for their children. Our local chapter of the American Academy of Pediatrics encouraged more pediatricians to enroll in Medicaid and VFC. Provider after provider took on the challenge and signed up for VFC! Now, most of the children who have Medicaid, or the state-based insurance program called Child Health Plus, have a medical home — and access to these free vaccines. 

Where are we now?

Today, it takes about 45 minutes to complete the provider agreement for NYDOH online. New York State Immunization Information System (NYSIIS) allows us to quickly determine the number of children in a practice, keep track of vaccines and inventory, and order more vaccine doses. NYSDOH has developed a series of mini-lectures all accessed through NYSIIS based on the most recent CDC policies. All VFC providers must review the mini-lectures annually as part of the VFC contract renewal process, and the “Pink Book” course continues to be highly encouraged. After I left SCDHS after 30 years of service, I set up my own private practice and registered for a VFC account. I found the process quick and easy, and there was a tremendous amount of support from NYSDOH. Of course, I was still nervous when the NYSDOH representative came to inspect my refrigerator and freezer! Luckily, I passed! 

I have seen a lot of firsts. I was a polio pioneer, a COVID vaccine pioneer and, of course, a VFC pioneer. Looking back, it’s unbelievable to me to see how our small clinics in churches and community centers grew into a reliable system that has prevented approximately 508 million cases of illness, 32 million hospitalizations, and over 1.1 million deaths — not just in New York but throughout the U.S.

Resources

Contributed by: Sharon G. Humiston, MD, MPH, FAAP

 

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