Sustainability of school-located influenza vaccination programs in Florida

Abstract

Background School-located influenza vaccination (SLIV) programs are a promising strategy for increasing vaccination coverage among schoolchildren. However, questions of economic sustainability have dampened enthusiasm for this approach in the United States. We evaluated SLIV sustainability of a health department led, county-wide SLIV program in Alachua County, Florida. Based on Alachua’s outcome data, we modeled the sustainability of SLIV programs statewide using two different implementation costs and at different vaccination rates, reimbursement amount, and Vaccines for Children (VFC) coverage. Methods Mass vaccination clinics were conducted at 69 Alachua County schools in 2013 using VFC (for Medicaid and uninsured children) and non-VFC vaccines. Claims were processed after each clinic and submitted to insurance providers for reimbursement ($5 Medicaid and $47.04 from private insurers). We collected programmatic expenditures and volunteer hours to calculate fixed and variable costs for two different implementation costs (with or without in-kind costs included). We project program sustainability for Florida using publicly available county-specific student populations and health insurance enrollment data. Results Approximately 42% (n = 12,853) of pre-kindergarten – 12th grade students participated in the SLIV program in Alachua. Of the 13,815 doses provided, 58% (8042) were non-VFC vaccine. Total implementation cost was $14.95/dose or $7.93/dose if “in-kind” costs were not included. The program generated a net surplus of $24,221, despite losing $4.68 on every VFC dose provided to Medicaid and uninsured children. With volunteers, 99% of Florida counties would be sustainable at a 50% vaccination rate and average reimbursement amount of $3.25 VFC and $37 non-VFC. Without volunteers, 69% of counties would be sustainable at 50% vaccination rate if all VFC recipients were on Medicaid and its reimbursement increased from $5 to $10 (amount private practices receive). Conclusions and relevance Key factors that contributed to the sustainability and success of an SLIV program are: targeting privately insured children and reducing administration cost through volunteers. Counties with a high proportion of VFC eligible children may not be sustainable without subsidies at $5 Medicaid reimbursement.

Influenza illness averted by influenza vaccination among school year children in Beijing, 2013‐2016

“…Healthy school‐going children, although excluded from the defined vulnerable populations, are at a higher risk of contracting the influenza virus because of the increased probability of transmission due to more frequent close contact within this age group . School‐based influenza vaccination programs have therefore been recommended in some settings as an extension of existing influenza vaccination programs but remain rare globally . In Beijing, in 2009, a free influenza vaccination policy was launched in primary, secondary, and high schoolchildren who are 6‐18 years old .…”

“…rare globally. 3,4 In Beijing, in 2009, a free influenza vaccination policy was launched in primary, secondary, and high schoolchildren who are 6-18 years old. 5 Temporary points of vaccination (POVs) are established at schools, and students with their parent's written consent are organized to receive the vaccination there.…”

Optimizing the impact of low-efficacy influenza vaccines

“…Citing the randomized trial (11), the Advisory Committee on Immunization Practices began recommending influenza vaccination for children (13). Since then, local public health agencies initiated school-located programs, demonstrated to be epidemiologically effective and economically sustainable (14)(15)(16). These implementations highlight the translation of modeling analyses to improve preventative health.…”

“…Health provider recommendation, email reminders from health maintenance organizations, workplace incentivization, and optout scheduling of vaccination appointments are also influential in promoting vaccination (22)(23)(24)(25). These efforts can be augmented by improving the accessibility of vaccination; for instance, through active recruitment at convenient locations such as pharmacies, retail establishments, community centers, workplaces, and schools (14,16,25,26). When herd immunity is anticipated to be inadequate to protect the elderly, our results highlight the importance of making an extra effort to encourage vaccination uptake in this age class.…”

Practical Approaches to Optimize Adolescent Immunization

“…68 Another program in Florida similarly found that school-located influenza vaccination programs can be economically sustainable by targeting adequate numbers of privately insured children and reducing costs through volunteers and mass vaccination. 69 • School nurses School nurses who are part of a school health program that is enrolled as a Vaccines ForChildren program provider play an integral role in achieving and maintaining high coverage of adolescent immunizations. 70 They can be valuable resources for delivering vaccines because of their knowledge of the school and its students, and access to immunization information systems may help increase their ability to provide vaccines to adolescent students.…”