Reflecting on the Future of US Vaccine Programs

The US government has been the sole purchaser of COVID-19 vaccines since they were authorized for emergency use by the Food and Drug Administration. This was a major departure from the customary public-private approach to vaccine programs wherein payers reimburse vaccines through health coverage and the federal government purchases vaccines for low-income children and some adults. Now, as that approach recedes, we are at a national inflection point in vaccine policy. There has been no “all of government” plan for the transition of the COVID-19 vaccine marketplace and no political acknowledgment of the need to continue prioritizing COVID-19 vaccination. Moreover, routine immunization rates have slowed throughout the pandemic as the threat and impact of respiratory pathogens has increased and we witness resurgence of previously well-suppressed diseases such as measles and polio.

As the federal government winds down its emergency response posture and conducts its post mortem, it has the opportunity and responsibility to seize the best aspects of the COVID-19 vaccination campaign, identify needed improvements to vaccine programs and infrastructure, and apply these learnings through reform of existing programs.