Bill Expanding Veteran Access to Immunizations Ignites Controversy

by U.S. Medicine

April 7, 2016

Pharmacists Take a Lead Role in Increasing Vaccination Rates

By Annette M. Boyle

VA Under Secretary for Health David Shulkin, MD, gets his influenza shot. VA photo.

VA Under Secretary for Health David Shulkin, MD, gets his influenza shot. VA photo.

WASHINGTON — An effort in the U.S. Senate to ensure that veterans have access to all recommended immunizations was about as routine as legislation gets, simply clarifying a section of the U.S. Code.

Yet, it has set off a frenzy among those in the anti-vaccination movement. Opponents to the bill claim on multiple websites that it aims to mandate veterans receive “over 90” vaccines.

The site activistpost.com maintains that the expanded access to immunization is cover for “biological warfare” and that the bill mandates that the VA “ensure that all veterans receive immunizations (vaccines) per a Draconian schedule.” Noting proof of immunity or receiving a number of immunizations is required to enter the military services, the critics said they see the bill as part of the “effort to extend the vaccine mandate to those who have previously served their country.” 

Another site, drrimatruthreports.com, claims that the bill gives the VA the “responsibility of mandating vaccines for all veterans. If they exercise their legally protected Right to Informed Consent, they can be denied all medical care.”

In reality, according to the language of the bill and the VA, nothing so drastic is at issue.

The VA makes a big push each fall to increase influenza vaccinations among veterans. VA photo

The VA makes a big push each fall to increase influenza vaccinations among veterans. VA photo

Senate Bill S. 1203, The Century Veterans Benefits Delivery and Other Improvements Act, passed the Senate and was sent to the House Armed Service Committee and House Veterans’ Affairs Committee in November. The section of the bill related to vaccines was first introduced by Sen. Jon Tester (D-MT) as S. 172, the Access to Appropriate Immunizations for Veterans Act. Tester has proposed the bill in several previous sessions, but this is the first time it has been included in a bill that passed the Senate.

The bill clarifies that the “preventive health services,” specified in Section 1701 of Title 38 of the U.S. Code, which details veterans’ benefits, includes every immunization on the schedule recommended by the Advisory Committee on Immunization Practices (ACIP) “at the time such immunization is indicated on that schedule.” ACIP makes recommendations for the use of vaccines to the director of the Centers for Disease Control and Prevention (CDC).

The background in the bill explains that, “veterans, particularly those at high-risk for vaccine-preventable diseases, may benefit from receiving each immunization on the recommended adult immunization schedule, as appropriate.”

The bill requires the VA to report to Congress each year on efforts to ensure veterans receive the immunizations when indicated on the schedule and submit a report within two years that details quality measures implemented to ensure timely receipt of immunization by veterans receiving medical services from the VA.

Many veterans’ organizations support the bill. For example, Raymond Kelley of the Veterans of Foreign Wars of the United States (VFW) testified that his group “believes the evidence is clear that vaccination is one of the safest, most cost-effective ways to prevent disease and death from infectious diseases.”

Kelley cited a study by the CDC finding that the number of deaths among adults potentially prevented by immunization exceeded the total number of deaths caused by breast cancer, colorectal cancer and prostate cancer combined.

He also favored establishment of clear quality metrics, noting that, when the VA established best-practice metrics for influenza and pneumococcal vaccinations, the immunization rates rose from 27% and 26% to 77% and 80%, respectively.

A statement submitted in support of the legislation by Thomas Snee, M.Ed., national executive director, of the Fleet Reserve Association, praised the bill for promoting timelier and appropriate vaccinations.

“This legislation is a win-win for veterans and the VA. The bill should in the long-term save money for the VA by preventing veterans from getting diseases,” Snee said.

chart

Source: Centers for Disease Control and Prevention
Click To Enlarge

Recommended Vaccines

The CDC recommends 14 immunizations for any adults: influenza, tetanus/diphterheria/pertussis, varicella, human papillomavirus, zoster, measles/mumps/rubella (MMR), pneumococcal 13-valent conjugate, pneumococcal polysaccharide, hepatitis A, hepatitis B, meningococcal 4-valent conjugate or polysaccharide, meningococcal B and haemophilus influenza type b (Hib).

Veterans are accustomed to receiving immunizations. Upon enlistment or accession, military personnel must document immunity, receive immunizations and/or receive boosters for tetanus/diphtheria (preferably with pertussis vaccine), varicella, MMR, hepatitis A, hepatitis B, and meningococcal as well as adenovirus and poliovirus. Servicemembers receive annual influenza vaccinations and might also receive a number of other immunizations, depending on their risk factors.

Within the VA, pharmacists have taken a leading role in expanding access to immunizations. “VA clinical pharmacists routinely participate in medical center-wide efforts to vaccinate veterans for influenza and pneumococcal,” said Jane Kim, MD, MPH, acting chief consultant for preventive medicine at the VA. As advanced-practice providers in the VA, they can also order vaccines.

“Clinical pharmacy specialists have a unique role to provide comprehensive review of medication therapy, clinical assessment of the patients for risk and benefits, contraindications and adherence with well-accepted practice guidelines and prescribing needed medications as direct care providers in VA,” Kim said, adding that makes them well-suited to not only advise veterans on appropriate immunizations but also to provide them.

The VA has focused on increasing influenza and pneumococcal vaccination rates over the past several years. The pneumococcal immunization program has been a notable success for the VA, with 92.5% of acute care inpatients over age 65 and 91% of outpatients have received a pneumococcal vaccination, Kim said.

Historically, about 70% of veteran receive the influenza immunization annually. A partnership announced last year with Walgreens was designed to make the flu vaccine more accessible, particularly to veterans who do not live near a VA medical facility.

Through the end of February, 1,651,297 flu vaccinations had been administered in VA outpatient facilities this flu season, Kim told U.S. Medicine. An additional 41,000 veterans have received immunizations at Walgreens, which have been documented in the VA electronic medical record.

This year, “there are no established national goals for patient flu vaccinations, but VHA does advise sites to narrow any vaccine uptake gaps in certain populations — African-Americans, Latinos, people under age 50, and women,” Kim added.


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