Analysis of the Federal Section 317 Immunization Program and Routine Adult Immunization Activities, United States, 2022-2023

Abstract

Objectives: The federal Section 317 Immunization Program, administered by the Centers for Disease Control and Prevention (CDC), provides funding to support adult immunization efforts; however, current information on program implementation at the jurisdictional level is limited. We assessed the use of Section 317 and other funding sources to support routine adult immunization activities among the 64 immunization programs ("awardees").

Methods: We conducted a survey and key informant interviews with awardees in October to December 2022 to collect quantitative and qualitative data on current adult vaccine purchase and program operation activities funded by Section 317 and other funding sources. We assessed total vaccine cost and data on vaccine purchase projections for each awardee with CDC's Cost and Affordability Tool for 2023.

Results: Immunization program managers or their designees from 62 of 64 awardees (97%) completed the survey; 12 awardees participated in key informant interviews. Of 62 awardees, 32 (52%) used a single funding source to support adult vaccine purchases, of which 29 (91%) used only Section 317 funds, 21 (34%) reported not planning to purchase ≥1 age-based recommended vaccine for adults in 2023, and 33 (53%) reported using Section 317 funds only to support adult immunization program operations. Key informant interviews showed varied operational activities among awardees, but 8 awardees stated the need for additional staff to expand adult immunization program services in health care provider education (n = 5), program administration (n = 5), and site visits (n = 6).

Conclusions: Additional efforts are needed to understand how to better support routine adult immunization activities implemented at the jurisdictional level.

Keywords: Section 317; adult immunization; immunization program; vaccination.

Figure 1.

Types of funding sources used to purchase Advisory Committee on Immunization Practices–recommended adult vaccines, according to a survey of federal Section 317 Immunization Program awardees, October 26 through November 23, 2022. Data are presented for 62 of 64 awardees (San Antonio, Texas, and the Marshall Islands did not participate in the survey). Funding options included state (S), local (L), or city (C) funds; Section 317 vaccine funds; state-levied fees from vaccine manufacturers; funds from health insurance (eg, health insurer fees); and external funds. Funding efforts limited to COVID-19 pandemic response efforts are not shown. Federal funding indicates the use of only Section 317 Immunization Program discretionary funds to purchase routine adult vaccines. Other indicates awardees that used the following funding combinations for adult vaccine purchase: state funds and health insurer fees (Mississippi); federal funds and health insurer fees (Vermont); federal funds, state funds, and health insurer fees (Arkansas and Rhode Island); and federal funds, state and local funds, health insurer fees, and state-levied fees (Alaska).

Figure 2.

Planned purchases of Advisory Committee on Immunization Practices–recommended vaccines among federal Section 317 Immunization Program awardees, by funding source, as self-reported by awardees using the Cost and Affordability Tool (CAT), March 10, 2023. Vaccines purchased with health insurance fees are not shown because this option is not included in CAT. Vaccines with age-based recommendations include influenza (flu); pneumococcal conjugate vaccine (PCV13); tetanus, diphtheria, and acellular pertussis (TDAP); hepatitis B virus (HEPB); and zoster virus (ZOS). Vaccines may be recommended and/or available based on health condition, travel requirements, and occupational needs; response to an outbreak of vaccine-preventable diseases; and public health preparedness exercise. Abbreviations: HEPA, hepatitis A virus; HPV, human papillomavirus; MCV4, meningococcal quadrivalent; MENB, meningococcal B; MMR, measles, mumps, and rubella; PPSV23, pneumococcal conjugate polysaccharide vaccine; VAR, varicella.

Figure 3.

Support for routine adult immunization program operations by funding source according to a survey of federal Section 317 Immunization Program awardees, October 26 through November 23, 2022. Data are presented for 62 of 64 awardees (San Antonio, Texas, and the Marshall Islands did not participate in the survey). Funding options included state (S), local (L), or city (C) funds or Section 317 operation funds, public health funds, private sector funds, and other program funds from the Centers for Disease Control and Prevention (CDC). Funding efforts limited to COVID-19 pandemic response efforts are not shown. Federal funding indicates the use of Section 317 operation, public health, and/or other CDC program funds to support routine adult immunization program operations. Other indicates awardees that used the following funding combinations to support adult immunization program operations: federal and private sector funds (Alaska, Vermont) or federal, state, and private sector funds (South Carolina).

Figure 4.

Number of federal Section 317 Immunization Program awardees that implemented routine adult immunization program activities, by funding source, according to survey responses, October 26 through November 23, 2022. Data are presented for 62 of 64 awardees (San Antonio, Texas, and the Marshall Islands did not participate in the survey). Federal funding indicates the use of Section 317 operations, public health funds, and/or other program funds from the Centers for Disease Control and Prevention to support operations for routine adult immunization programs. Other indicates awardees that used a combination of federal, private, and state (S), local (L), and city (C) funds (Alaska, South Carolina, Vermont) or that used only S/L/C funds to support operations of routine adult immunization programs (Mississippi, US Virgin Islands).