IOM report on national vaccine plan

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."

Source: National Academy of Sciences