A summary of presentations from the weekly Summit partner webinars

May 26, 2022 – The latest Summit summary

Vaccines for Adult Proposal in FY23 Budget Megan Lindley (CDC)

Megan Lindley, MPH, Senior Advisor, Office of Adult and Influenza Immunization, Immunization Services Division, NCIRD, CDC, presented the Vaccines for Adult (VFA) Proposal in the FY23 budget.

There are three longstanding barriers to vaccine uptake that are affecting real people:

  • Accessibility – The lack of access to health insurance or a provider and transportation to get to healthcare
  • Availability – Lack of or inconsistent coverage across healthcare plans, as well as inconsistent outreach and engagement from health systems
  • Confidence – History of disparities and discriminatory patterns and rise in mis- and dis-information about vaccines

CDC deployed billions in COVID-19 response funding to hundreds of national, state, local, and community partners:

  • Partnering for Vaccine Equity (P4VE) – Working to increase vaccine equity and uptake in racial and ethnic minority communities
  • VTF Vaccine Confidence and Demand (VTF VCD) – Building vaccine confidence and generating demand in the general population
  • Disproportionately Affected Adult Populations (DAAP) – Supporting access to and uptake of vaccines for adult populations disproportionately impacted by COVID-19
  • State, Territorial, Local, and Tribal Programs – Supporting equitable COVID-19 vaccine access and expanded partnerships with communities

Part of the supplements that CDC has provided to the immunization awardees requires awardees to make sure funding is directed toward disproportionally impacted populations and community activities as well as required to be given directly to community partners.

Recent data suggests that the efforts of the partner network contributed to a reduction in racial and ethnic disparities in COVID-19 vaccination rates. The rate for Hispanic/Latino individuals nationally is now equal to that for White individuals, and the rate for Black individuals appears to be increasing. CDC will be publishing an MMWR in the next month.

The rapid COVID-19 vaccination rollout and collective efforts of CDC and partners have saved many lives. Data from July 2021 suggests that if there had not been a COVID-19 vaccination program, the daily deaths from the SARS-CoV-2 virus would have created a second surge in the spring of 2021, potentially larger than the first wave in January 2021.

The efforts and investments have created momentum toward a comprehensive adult immunization program. Funding through partners at the national, state, local, and community levels will allow CDC to implement a comprehensive program with activities that reinforce and build on each other to improve vaccine confidence among racial and ethnic minority groups:

  • Ten billion dollars has been invested to expand access to and confidence in COVID-19 vaccines in the highest-risk communities
  • Free COVID-19 vaccines have been available for all during the pandemic
  • New partnerships have been established with pharmacies across the U.S.
  • Funding and support have been deployed to hundreds of partners to address racial and ethnic disparities

Significant additional investments will be required to sustain the progress already made using the COVID-19 funding and authority. Future work depends on effectively addressing several challenges:

  • Sustaining progress in reducing immunization disparities
  • Building new partnerships and activities at the community level
  • Finding more permanent solutions that don’t rely on emergency dollars
  • Addressing the risk of long-term declines in routine vaccinations in people of all ages

The Vaccines for Children (VFC) program provides a framework for building a comprehensive adult immunization program. VFC is a federally funded program, established in 1993 that provides no-cost vaccines to children whose families cannot afford vaccinations. Mandatory funding that provides children with free vaccines is just one element of a comprehensive program that also relies on extensive public health infrastructure and discretionary CDC programs for its success.

See: Long-Term Payoff: An Economic Perspective on Immunization

Since the Start of the Vaccines for Children Program, Uptake Has Increased, and Most Disparities Have Decreased

The proposed Vaccines for Adults (VFA) program would increase vaccine access, reduce the spread of vaccine-preventable diseases, and pave the way to greater health equity for adults. The VFA program includes:

  • Vaccine Purchase – Purchase of recommended vaccines for all uninsured adults
  • Program Operations – CDC staff and systems for scientific and policy support, program monitoring, and vaccine safety and distribution
  • Provider Fees – Covering the cost of supplies, patient education, storage, and staffing
  • Provider Fee Management – Contracts to administer the provider reimbursement process
  • Vaccine Confidence and Equity Activities – Support vaccine equity through partnerships, communities, and technical assistance. This not part of the newly proposed mandatory funding proposal that would support the rest of these activities; this would be funded in the FY23 CDC Budget with base immunization funding.

VFA would cover the 14 ACIP-recommended adult vaccines and any additional vaccines recommended over time with no cost-sharing.

CDC has proposed significant new funding for VFA. CDC’s FY23 budget request of 2.1 billion dollars in funding for VFA will expand access to all routine and outbreak vaccines to uninsured adults. The total program cost request is $25 billion over ten years.

The proposed VFA program would be a major step toward addressing the key barriers to vaccination.

  • The program would allow access to all ACIP-recommended vaccinations for uninsured adults at no cost
  • There will be more widely available vaccines with increase in purchase and distribution
  • Adequate payment for providers administrating vaccines will increase availability in different settings
  • There will be adequate funding to continue activities for increasing vaccine confidence and health equity

With the VFA program, the uninsured may have meaningful access to vaccines for the first time. However, these are not the only groups of adults that experience barriers to vaccine access. VFA would cover the cost of vaccines for uninsured adults only, however, the underinsured, Medicaid enrolled, Medicare enrolled, and privately insured would not be covered by this program. Other funding would be needed.

VFA would complement other proposals in the FY23 Budget that also extend critical access to vaccinations. Complementary proposals in the FY23 Budget include:

  • Expanding the VFC program to all children under age 19 enrolled in CHIP and updating the provider administration fee structure to increase provider capacity and eliminate cost sharing for VFC-eligible children
  • Consolidating Medicare vaccination coverage under Part B so more preventive vaccines are available at no cost to Medicare beneficiaries
  • Increased investments in CDC’s discretionary Section 317 immunization program to expand existing efforts to enhance the adult immunization infrastructure, detect and respond to outbreaks of VPDs, and address vaccine hesitancy

These complementary proposals along with VFA would reduce disparities in vaccination coverage, improve control of vaccine-preventable diseases, and enhance and maintain infrastructure for responding to future pandemics.

VFA is just one, critical piece of the vaccination coverage puzzle, however, there are many components to complete the vaccines safety net and ensure equitable access to vaccinations:

  • Covered under current law
    • Existing Medicare, Medicaid, and VFC programs
    • ACA-compliant private insurance
    • Existing 317 funds
  • Proposed in the FY23 President’s Budget
    • Expanded VFC coverage
    • Vaccines for Adults program
    • Requested $379 million increase in 317 Funds
    • Expanded Medicare coverage
  • Not currently covered by proposed or current law
    • Expanded Medicaid coverage (proposed in the Build Back Better Act)
    • 317 Funds for underinsured and infrastructure



Do you anticipate that the VFA program would work like the VFC program, where the CDC funding would go to the states and they would administer the money? What vaccine providers does CDC anticipate would participate in this program?

Megan Lindley

We don’t know if there is planning at that level of detail yet. It will be likely that the program will resemble VFC because we have seen the success of that program and we have some very extensive infrastructure, processes, and systems in place that have been tested and refined over the years which would make it easier for the states to order the vaccines that they need.

It is difficult right now to tell who would participate in the program, we are just hoping that the budget proposal gets through and some authorizing legislation does, as well. What’s important is that this could create a strong connection to the primary care network, and we need to make sure that vaccines would be accessible to people at these locations so that vaccines are getting to the people who need them.


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