Protecting the Public's Health: Critical Functions of the Section 317 Immunization Program—A Report of the National Vaccine Advisory Committee

CommitteeVaccines are one of our most successful tools for protecting the public's health.It seems simple: a pharmaceutical company develops a new vaccine, the U.S. Food and Drug Administration (FDA) licenses it, health-care providers give it to their patients, and we see disease disappear.But vaccination in the United States is much more complex and only made possible through a robust public-private partnership that begins with the development of the vaccine and continues long after it is used routinely.Along every step of the way, public health-at the national, state, and local levels-plays a fundamental role.The success of the pneumococcal conjugate vaccine (PCV) in preventing suffering, disability, and death is one example that illustrates the essential role of our nation's public health systems and workforce in protecting us from vaccine-preventable diseases (VPDs).Streptococcus pneumoniae (pneumococcus) is a major cause of invasive disease, including meningitis, pneumonia, and bacteremia.In the absence of a pediatric vaccine, pneumococcus was a significant public health concern, causing approximately 63,000 cases of invasive pneumococcal disease and 6,100 deaths in the U.S. each year. 1 Young children and older adults are especially vulnerable, and many children who develop pneumococcal meningitis have long-term complications such as deafness or seizures.In 2000, a pediatric heptavalent PCV (PCV7) was licensed for use in the U.S.There are more than 90 strains of pneumococcal bacteria, and PCV7 provided protection against seven of them.Before PCV7 was introduced, these seven strains caused more than 80% of severe pneumococcal infections among children. 2 Most health-care providers in the U.S. look to public health for guidance in the use of vaccines.After a careful review of the evidence, including data about the burden of disease caused by pneumococcus, the effectiveness and safety of the vaccine, and the feasibility of incorporating it into the immunization program, the Advisory Committee on Immunization Practices (ACIP) made a recommendation for the routine use of PCV7 among children, 2 and the Centers for Disease Control and Prevention (CDC) incorporated it into the immunization schedule, which gives doctors specific recommendations for the use of vaccines across the life span.Public health helps inform people about the vaccines they need and the risks and benefits of receiving vaccines.Parents consider many factors when deciding to vaccinate their children.Using science-based strategies, public health provided parents with information about the risks of pneumococcal disease and the benefits of the new vaccine.State and local public health experts worked with the health-care providers in their communities to make sure they had the National Vaccine Advisory Committee NVAC Report: Critical Functions of the Section 317 Immunization Program  79 Public Health Reports / March-April 2013 / Volume 128tools they need to help their patients make informed decisions, from how to hold a child during a vaccination to responding to questions about the need for, and the safety of, the vaccine.Vaccine supply interruptions are managed by public health to ensure that those most at risk can be protected first.Following the 2000 recommendation, the supply of PCV7 vaccine did not keep up with demand.3 Because some children are at higher risk of disease and/or its complications than others, public health was called upon to help conserve vaccine and direct it to protect those children at highest risk.CDC issued interim vaccination recommendations to withhold vaccine from healthy children aged 2 years and older, and to defer some doses for healthy children who were younger than 2 years of age. 4 Public health experts and systems at the state and local levels provided strategies for implementing the vaccination guidelines, such as using immunization registries to identify those children who need to be vaccinated and issuing reminders to parents to get them vaccinated.Public health continued to monitor the supply of PCV7 and, in 2004, when the supply stabilized, public health terminated the interim recommendations so that the vaccine could be used according to the 2000 recommendation.5 Public health evaluates our national vaccine programs and policies.Post-licensure evaluation of vaccine performance is necessary to ensure that vaccines have the intended public health impact.In the first five years that PCV7 was used, the incidence of invasive pneumococcal disease in children fell by 94%.6 In addition to the protection provided to vaccinated children, the work done by our public health systems and experts demonstrated that the vaccine also significantly reduced transmission of pneumococcus to unvaccinated people, including adults.Public health data from Active Bacterial Core surveillance (ABCs) showed a more than 90% decrease in the rate of invasive pneumococcal disease caused by the vaccine serotype disease among people aged 5 years and older, with a dramatic decrease in disease among adults 65 years of age and older.6 In addition to impressive reductions in disease, economic analyses conducted by CDC showed that every $1 invested in PCV7 resulted in a cost savings of $1.50.7 This type of information informs our national strategies for preventing invasive pneumococcal disease, including the best investment of health-care resources.Public health data are critical to the development of new and better vaccines.Over time, public health's pneumococcal surveillance showed that while there were significant reductions in disease caused by the pneumococcus serotypes prevented by PCV7, there were increases in invasive disease caused by non-vaccine serotypes.