1. State Health Agency Perspectives on the Implementation of New Vaccines Presentation to the National Vaccine Advisory Committee September 26, 2006 Calvin B. Johnson, MD, MPH Secretary of Health Pennsylvania Department of Health

2. About ASTHO ASTHO is the national nonprofit organization representing the 57 state and territorial public health agencies of the United States, the U.S. Territories, and the District of Columbia. Immunization is a key issue for both ASTHO and the states.

3. Implementing New Vaccines is a Complex Process Begins with an ACIP recommendation, and occurs over a period of months. –Education of providers and the public –New programmatic infrastructure –Adapting immunization registries –And more…

4. State Health Agency Concerns The primary concern is financing –States are contributing significant resources, but flat federal funding for Section 317 is an increasing problem…

5. Cost of Vaccines to Immunize 1 Child vs. Annual Federal Vaccine Purchase Appropriations Vaccine cost to immunize 1 child Vaccine purchase appropriation $819 $263 M $186 $138 M March 2006

6. The Cost of Vaccine to Immunize One Child in the Public Sector 1.Estimated costs; CDC contracts have not been finalized. 2.2 doses are needed the first year of vaccination and 1 dose of vaccine is needed annually thereafter. Excise tax effective in 2005. 3.In 2000, the PCV cost to fully vaccinate 1 child is for half the calendar year. The CDC contract was not in place until July 1, 2000. 4.Tdap replaced TD as the adolescent booster recommended by ACIP in June 2005. 5.The cost of recommended vaccines is significantly higher when combination vaccines are factored in to the total cost. While combined vaccines require fewer injections and office visits, this table shows only the lower cost of single vaccines. Source: Centers for Disease Control and Prevention 19992000200120022003200420052006 est. 1 DTaP$46.25 $51.40$59.65$61.70$62.05$62.99$64.18 Hib$20.44$21.96$23.96$28.44$31.44$33.60$30.24$30.87 MMR$29.38$30.16$30.84$31.22$31.80$32.38$33.34$34.00 Polio$27.96$31.00$32.52$34.64$38.68$40.40$41.68$42.57 Hep B$26.85$27.18$27.00$28.11$27.00$27.45$27.48$28.06 Varicella Flu $35.41 -- $37.14 -- $38.64 -- $40.87 -- $43.42 -- $47.02 $30.00 2 $52.25 $31.40 $53.43 $32.08 PCV-- $88.50 3 $183.96 $190.76$203.00$216.48$221.39 Tdap-- $29.55 4 $30.18 MCV-4-- $68.00$69.55 Hep A-- $24.26$24.79 Rotavirus -- $187.50 TOTAL$186.29$282.19$388.32$406.89$424.80$475.90$617.67$818.60 5

7. Immunization Mandates Two principles must be considered: –The role of the State Health Agency in formulating sound state public health policy –Possible unintended consequences of exemptions

8. ASTHO HPV Website Visit www.ASTHO.org

9. HPV and Cervical Cancer Fact Sheet

10. THANK YOU ASTHO 1275 K Street NW, Suite 800 Washington, DC 20005 (202) 371-9090 www.ASTHO.org