| Overview
In
2003, NIP conducted a review of the existing system by gathering
information across all parts of the vaccine supply chain,
including vaccine manufacturers, third party vaccine distributors,
state and local health departments, and medical providers.
Through
this review, a number of priority
areas were identified including
funds management, vaccine distribution,
provider ordering, inventory management,
and the operation of the national
pediatric stockpile.
Background
The
National Immunization Program (NIP)
purchases and makes available over
60 million doses of pediatric vaccine
to both public and private immunization
providers each year. This accounts
for almost 60% of the pediatric vaccines
used in the country. The bulk of this
vaccine is made available through
the Vaccines for Children (VFC) program.
This program provides federally-purchased
vaccines to all children from birth
through 18 years of age if they:
- Are enrolled in Medicaid; or
- Have no health insurance; or
- Are an American Indian or an Alaska Native
In
addition, children who are insured but whose health insurance
does not cover immunizations ("underinsured") are
eligible for VFC vaccines at Federally Qualified Health Centers
(FQHC) or Rural Health Clinics (RHC).
The
VFC program is a recognized success: raising provider enrollment
in the VFC program, which in turn has led to increased access
to affordable immunizations for eligible children and improved
national immunization coverage levels. Most methods and processes
used to manage vaccines are derived from models put into place
with the inception of the VFC program ten years ago, and some
processes were first used as early as the 1960s. There is
no uniform process to manage and track vaccine inventories
and no electronic or automated system to support the distribution,
supply, and availability of vaccines.
In late 2003, as a result of direction from the President's
Management Agenda and mandates from the Department of Health
and Human Services (DHHS), NIP began to take steps to improve
the business aspects of its vaccine management system. Simultaneously,
new requirements, such as implementation of a national pediatric
vaccine stockpile and required changes in funding practices,
forced NIP to re-examine its basic operating model for vaccine
delivery and accountability.
Because
of the increased complexities in the program, the vaccine
ordering, distribution and accountability processes that were
adequate to manage the program in 1994 do not meet the public
health needs of the 21st century. In an effort to address
these concerns, the Vaccine Management Business Improvement
Project was initiated in early 2004.
First Steps
The
early part of 2004 was spent developing a baseline understanding
of the entire vaccine supply chain, from the vaccine manufacturers
to the immunization providers. A team, led by CDC staff assigned
to coordinate this project, visited ten state and local immunization
projects. They also visited all four of the vaccine manufacturers
and two of the vaccine distributors that currently supply and
distribute vaccine for the VFC program. With this information,
the team was able to examine many aspects of the program, including
vaccine funds management, vaccine distribution, vaccine ordering
at the clinic level, inventory management, and the operation
of the national pediatric stockpile.
In
April 2004, the team presented its findings to CDC and NIP
leadership. The recommendation was for a much more consolidated
approach to ordering and distribution. This new model was
a bold departure from the very fragmented and decentralized
approach that is currently in place and would allow CDC to
see where the vaccine is located in the supply chain - a very
important advantage to professionals who are working to improve
public health.
Since early fall 2004, the project has engaged over 70 staff from federal and state immunization programs. There are working teams for all major aspects of the program: Ordering and Distribution, Vaccine Stockpile, Systems, Fiscal Operations, Vaccine Management and Accountability, and Communications. |
