Saving Tax Dollars… Through Spending
By Bruce Ruscio, DrPH, and Karl Moeller, MPA
Can the federal government save money by spending it? It seems crazy on the face of it, but vaccines are among the most cost-effective ways to prevent disease and reduce health care costs. The human and economic impact of providing vaccines in keeping with the CDC’s current routine childhood immunization schedule prevents more than 40,000 deaths and 20 million cases of disease. It saves more than $10 billion in direct medical costs for each birth cohort vaccinated – costs which we would all pay one way or the other.
The CDC’s Section 317 immunization program, which supports critical public health immunization infrastructure and provides vaccine services to low-income and uninsured children, adolescents and adults, is paid for with non-defense discretionary funding. It serves all states, territories and protectorates, and provides vaccines to underinsured children and adolescents. It is also under threat of major cuts after the election. The threat comes from several directions.
The president’s FY 2013 funding proposal includes cuts of $58M for Section 317 Immunization Programs – or a cut of approximately 7.5% from 2012. This would result in fewer vaccinated children, a rise in preventable diseases and a real risk of increased morbidity and mortality rates. Such a cut would also increase the burden on our health care system and result in higher costs down the line.
While the president’s request lists specifics, the House Republican funding proposal for FY13 cuts the CDC’s overall program budget by $593 million below the president FY13 request. In that scenario, the 317 program may well be at greater risk.
There remains the threat of sequestration, which would have an even greater impact on vaccine preventable disease programs. According to a report by Senator Tom Harkin, the chairman of the Senate Appropriations Subcommittee on Labor, Health and Human Services, and Education, sequestration would mean 211,958 fewer vaccinated children in FY13.
Congress can cut funding for the Centers for Disease Control and Prevention, literally, overnight – yet history tells us prevention programs are costly and difficult to re-establish. An effective immunization program is more than just providing vaccine vials to providers. These programs include vaccine management efforts, disease and vaccine expertise, risk communications, disease surveillance, and workforce programs, among other system elements needed to ensure high vaccination coverage levels.
In 2000, an excellent article by Johnson, et al (see footnote) reviewed more than four decades of the Section 317 funding. The study found that when policy makers in Congress and the White House understood a new problem, epidemic or new vaccine, they supported the program with funding and policies. Conversely, when a crisis was resolved, funding contracted until the inevitable next disease crises emerged. What may be new is that these cuts are coming at a time when more and more parents have concerns and questions about vaccinations and when vaccine-preventable illnesses outbreaks of whooping cough and measles are occurring in our cities and towns.
The truth is that steady funding would save more lives and prevent more illness, but underappreciating prevention is a chronic condition among many policy makers. Surely, the current budget cage-rattling is troubling for public health funding, but even more disturbing is the trend for prevention programs generally. We should think long-term and spend now to save later.
Johnson KA, Sardell A, Richards, B. Federal immunization policy and funding: a history of responding to crises. Am J Prev Med 2000, 19:99-112.
