Volume 3, Number 3
Carryover and total federal funds available for immunization operations grants |
(Washington) A shortage of federal funds for immunization operations is likely to slow plans for new hepatitis B catch-up programs in the states, as well as new programs to control hepatitis A. Total funds available for operations in this fiscal year will be about $130 million, which is $65 million lower than in FY 1998 and $151 million lower than in FY 1997.
The origin of the current shortfall is traceable, somewhat paradoxically, to a dramatic increase in federal funding for immunization in the early 1990s, according to William P. Nichols, Associate Director for Management and Operations at CDC's National Immunization Program (NIP). Nichols commented on the issue in a speech before the December 1998 Every Child By Two Partners Conference in Washington.
In FY 1992 and 1993, federal funding for immunization operations (such as nurses salaries, clinic hours, etc. - called Financial Assistance or FA funds) nearly tripled, from $33 million to $97 million. The increase was good news for immunization programs across the country. But the programs could not gear up their administrative systems to spend the new money quickly enough, and much of the money went unspent. Under federal law, funds not expended in a particular year may be "carried over" to subsequent years. At the beginning of FY 1994, these carryover funds had ballooned to over $100 million (see story in the Hepatitis Control Report, Winter 1997-98 issue).
In 1994, the huge carryover caught the disapproving eye of Congress. But, instead of cutting just carryover funds, Congress cut NIP's base appropriation for operations. The cuts were severe, amounting to more than $86 million over the past five years (see figure 1).
Carryover funds have now dwindled to about $10 million and are expected to disappear completely in FY 1999. But the President's FY 1999 Budget Request did not restore any of the earlier cuts in NIP's base appropriation. In the October omnibus budget deal, NIP got only $120 million in new FA Funds. Compared to the $195 million the agency spent in FY 1998, this was a truly significant drop, and it will have profound effects on immunization operations in the states.
During FY 1998, as NIP realized that FA Funds would become scarce, it began to focus on the "core functions" of immunization programs, such as surveillance, responding to disease outbreaks, delivery of vaccine, training, and other indispensable activities. For FY 1999, these will remain the focus. Non-core functions, such as immunization registry development, will be deferred.
Some states have said that their ability to fund new ACIP-recommended hepatitis B catch-up programs in 1999 will be hurt by the federal cuts. Other states, including California and Texas, have warned that the cuts will limit their ability to start new vaccination programs against hepatitis A.
Meanwhile, the Senate Appropriations Committee has asked NIP to provide better data on the actual funding needs for future years. In its report accompanying the October omnibus appropriations bill, the Committee noted that "since 1994, over $2,300,000,000 in discretionary funds has been provided to the CDC for immunization activities, with a significant proportion of those funds allocated to State immunization programs." The Committee said that it was "concerned about future funding for immunization activities and is interested in evaluating the relationship between funding levels over the past five years, and corresponding coverage and disease rates."
The Committee asked NIP to collaborate with the Institute of Medicine on a study that asks the following questions: 1. to what extent has increased federal spending during the 1994-1998 period affected the nation's immunization coverage rates, 2. how were the new funds spent by the states and to what extent did states maintain their own level of effort over the past five years, 3. what are the current and future funding requirements for childhood immunization activities and how can those requirements be met through a combination of state funding, federal immunization funding, and through the Children's Health Insurance Program (CHIP), 4. how should federal grant funds be distributed among the states, and 5.how should funds be targeted within states to reach high-risk populations without diminishing high levels of coverage in the overall population?
Depending upon the Committee's satisfaction with the answers to these questions, it may recommend supplemental funding for NIP later in FY 1999. In the meantime, however, states are proceeding cautiously, if at all, on new immunization efforts, including new hepatitis A and B immunization programs.