When it comes to saving lives and minimizing health care costs, vaccinating children against infectious diseases is one of the most cost-effective public health interventions. In the United States alone, over the last 20 years childhood immunizations have prevented 322 million illnesses, 21 million hospitalizations, 732,000 deaths, and saved nearly $1.38 trillion in total societal costs.
Unfortunately, childhood vaccination programs are on the chopping block in the current administration’s 2018 budget proposal and various proposals to replace the Affordable Care Act. These vaccine programs directly affect the lives of children from every community in this nation.
Immunizing children prevents the spread of infectious disease across communities and across the nation. Even more important, it helps prevent the devastating and costly disabilities that can be caused by vaccine-preventable infections such as hepatitis B, human papillomavirus, measles, and meningitis. These include developmental delays, blindness, deafness, paralysis, amputations, and even cancer, all of which I have seen firsthand during my career as a pediatric infectious disease physician.
A core principle of the ACA is to ensure that people have access to vital preventive care services, including all recommended vaccines. To help promote that goal, the ACA called for the creation of the Prevention and Public Health Fund in 2010 to supplement core public health programs. As the largest fund for disease prevention in the federal budget, this fund provides almost $1 billion annually to the Centers for Disease Control and Prevention, accounting for about 12 percent of the CDC’s total budget.
The Prevention and Public Health Fund also provides about 45 percent of the total funding for the Section 317 federal vaccine program, which is used to buy vaccines and fund immunization programs in all 50 states. These funds also support the Vaccines for Children Program, which makes vaccines available to all children regardless of insurance status or ability to pay.
Eliminating the Prevention and Public Health Fund, which was proposed as part of the current administration’s fiscal year 2018 federal budget, would shrink existing public health initiatives at the state and local level and threaten the health of Americans, especially children.
Perhaps the most damaging cuts would be those proposed to Medicaid in the recent ACA repeal debate. Such drastic cuts would result in millions of adults and children losing access to insurance coverage, and therefore vaccines, over the next 10 years. Medicaid, combined with the Section 317 and Vaccines for Children programs, have helped to eliminate racial and ethnic disparities in vaccine-preventable infections in the United States.
Controlling infectious diseases takes vigilance. Measles, which once affected nearly all American children, caused swelling of the brain in about 4,000 cases of infected individuals, and killed 400 to 500 each year, now occurs far less often, thanks to vaccination. But cases still emerge regularly in the United States. These cases result in unnecessary public health costs, which are borne by taxpayers.
The Disneyland measles outbreak in 2015 was estimated to have resulted in $1.6 to $3.9 million in public health costs aimed at controlling the outbreak. There are additional costs associated with direct health care for measles. Approximately 25 percent of people who develop measles are hospitalized, with each stay averaging about $22,000. Measles can result in long-term disability and even death in about one out every 1,000 infected, generating costs that are hard to define, but that are steep for individual victims of disease, the families that care for them, and for society.
A recent study indicates how fragile our vaccine infrastructure is. Investigators in Texas and California demonstrated that a reduction in measles immunization of just 5 percent would result in triple the number of cases. These cases, like all vaccine-preventable infections, would result in real disease with real consequences, both economic and human.
The bottom line is simple: Without adequate funding, vaccinations will be less accessible, the health of our children will suffer, and the future of America — including our economy — will be compromised. No matter what legislation passes in Washington, we must safeguard existing benefits for all children including access to all recommended immunizations. If we can’t provide preventive health care for our youngest citizens today, the long-term costs for America will be higher tomorrow than we can afford.
Carrie L. Byington, M.D., is dean of the Texas A&M College of Medicine; senior vice president of the Texas A&M University Health Science Center; vice chancellor for health services at the Texas A&M University System; and chair of the American Academy of Pediatrics Committee on Infectious Diseases.
