Summary

The Vaccines for Children program was authorized by Congress in 1993 in order to increase immunization rates through free vaccinations. Plans by the Centers for Disease Control (CDC) to implement the program by October 1, as required by law, appear to be lagging behind schedule. With little margin for error, the program may not be up and running on time. GAO examined CDC's implementation plans and concluded that the time line is very ambitious. Several tasks integral to full implementation of the program are experiencing delays, including awarding contracts to vaccine manufacturers, developing plans for provider enrollment, and designing a vaccine distribution service that ensures the vaccine will not lose potency during shipment. Other components of the plan may need revision; for example, a proposed administration fee schedule may impose a financial burden on some program recipients, a consequence inconsistent with the program's stated goal of removing cost as a barrier to immunization. GAO also expressed concern that CDC has not yet developed plans for evaluating the program; without evaluation steps, it will be difficult to measure the impact of the program on immunization rates. GAO summarized this report in testimony before Congress; see: Vaccines for Children: Major Implementation Hurdles Remain, by Kwai-Cheung Chan, Director of Program Evaluation in Physical Systems Areas, before the Subcommittee on Labor, Health, Human Services, and Education, Senate Committee on Appropriations. GAO/T-PEMD-94-29, July 21 (12 pages).

GAO found that: (1) as of July 5, 1994, only 4 of the 15 contracts with vaccine manufacturers had been awarded; (2) as of June 28, 1994, only 5 of the immunization projects surveyed had mailed VFC enrollment forms to potential vaccine providers; (3) although VFC provides for free vaccines, providers may charge administration fees; (4) to ensure physician participation, CDC has established a maximum administration fee schedule for vaccine providers based on physicians' prevailing charges; (5) the CDC pay schedule appears to be inconsistent with VFC goals and could impose a financial burden on some VFC recipients; (6) although CDC arrangements for training state staff in the use of vaccine-ordering software appear to be on schedule, some states have not yet hired or selected the staff who will be using the software; (7) CDC did not conduct a systematic review of private distribution options before choosing the General Services Administration (GSA) for vaccine distribution services; (8) states bear primary responsibility for developing mechanisms to ensure accountability for federally-purchased vaccines; (9) CDC does not have an evaluation plan to assess the cost and effectiveness of the VFC Program; (10) CDC has failed to ensure that the components of the program are properly integrated; and (11) CDC needs to take overall responsibility for ensuring that the vaccine is distributed in a timely manner.