Transition Plan for Healthy Children


At the end of the 2oth Century, the Centers for Disease Control and Prevention (CDC) named vaccines as one of the top ten greatest achievements of biomedical science and public health. The development of vaccines helped eradicate smallpox, eliminate polio from most of the world, and dramatically reduce the transmission rates of measles and Hib invasive diseases among children. The COVID-19 pandemic has again demonstrated how crucial vaccines are for controlling the spread of infectious diseases. However, even before the pandemic, there were increasing numbers of families who were hesitant to vaccinate their children. The administration must promote the importance of vaccines, ensure their proper administration, and fund research to support continued vaccine development and research.

Ensure that children are included in COVID-19 vaccine trials. The Food and Drug Administration (FDA) and CDC should encourage manufacturers to include children in vaccine trials as soon as safe and appropriate to best understand any potential unique immune responses and/or unique safety concerns. Questions about unknown safety concerns will not be answered by merely posing questions, but only through carefully designed trials which include children. Without public data on the safety and efficacy of a COVID-19 vaccine, parents will be reluctant to have their children receive the vaccine.

Prioritize childhood vaccination within the pediatric medical home. Most children and adolescents receive vaccines as part of routine well-child check-ups, when other important health care is provided, including developmental and mental health screenings, counseling about nutrition and injury-prevention, and chronic disease management. The administration should rescind the Third Amendment to Declaration Under the Public Readiness and Emergency Preparedness (PREP) Act for Medical Countermeasures Against COVID–19 that supersedes state law by authorizing pharmacists to administer vaccines to children ages 3 to 18. This unnecessary declaration inappropriately separates vaccine administration from the medical home.

Enhance efforts to reduce vaccine hesitancy. Despite the fact that vaccines are safe, effective and save lives, there has been an increase in the number of Americans who are hesitant to have themselves or their children vaccinated. This rise in hesitancy is largely due to the proliferation of online misinformation spread on social media platforms. Restoring confidence in the safety and effectiveness of childhood vaccines is crucial for the existing series of childhood immunizations, but also for a successful uptake of a COVID-19 vaccine. As such, the CDC needs to be supported and given the proper resources to promote vaccine confidence through a national public messaging campaign.

Appropriately value vaccine administration. In order to support physicians who administer vaccines, the Centers for Medicare and Medicaid Services (CMS) should finalize its proposed calendar year 2021 national payment amounts for immunization administration services in the 2021 Medicare Physician Fee Schedule and encourage adoption of these payment rates by state Medicaid programs.

Allow Vaccines for Children (VFC) payment for multi-component vaccines. One of the most commonly used codes in pediatric care is CPT code 90460, which is used for immunization administration for patients through 18 years of age, including counseling regarding the first or only component of each vaccine or toxoid administered. CPT code 90461 was designed to account for the counseling associated with each additional vaccine component or toxoid administered. Currently, CMS disallows the use of CPT code 90461 by VFC providers. As such, Medicaid programs are not able to pay pediatricians appropriately for the additional documentation and counseling expense associated with administering multi-antigen vaccines. This policy imposes financial hardship on VFC-participating providers and adds to the burden of participating in the VFC program.

Reduce regulatory burden in the VFC program. The VFC program is a crucial component in the childhood vaccine delivery system. In order to make it easier for providers to participate in the program, Health and Human Services (HHS) should require all VFC programs to work with VFC providers to minimize the impact of regulations on sustained participation in the program. CDC should make permanent new pandemic-related flexibilities allowing for bidirectional borrowing between public and private vaccine stock to ensure that children get vaccines without having to return for another visit whenever possible. VFC programs should work collaboratively with providers to avoid or correct suspension of VFC participation privileges for minor issues.

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American Academy of Pediatrics