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Photograph © Jim West/Alamy |
If you’re looking for a public health success story, it would be hard to do any better than the Vaccines for Children (VFC) program. Then President Bill Clinton and the U.S. Congress enacted the VFC legislation in 1993 with a simple goal: to provide federal funds so that all U.S. children could have access to the recommended vaccinations at no cost. Since then, the rate of overall immunization coverage has risen significantly and is now at record levels; 90 percent of 2-year-olds are immunized against the major childhood diseases. Thanks to the VFC program, which provides about 43 percent of all childhood vaccines in the country, most virulent infectious diseases have been nearly eliminated in the United States. The program is one of two national immunization programs run by the Centers for Disease Control and Prevention (CDC). The VFC’s success is a tribute to years of perseverance and dedication on the part of the countless public health professionals who have built the program into the CDC’s biggest — and into a leading example of a thriving public–private partnership.
Of course, any program that extends into every state and U.S. territory bumps up against concerns. In the case of VFC, the details of implementation were left up to federal, state, and local health-care agencies. What resulted was a collection of state and local agencies and systems that grew in complexity as the program expanded. It went from administering six vaccines, at an annual cost of US$200 million in 1994, to administering 12 vaccines today at a cost of $3 billion. (See Exhibit 1.) The program made available the recommended immunizations from birth through 18 years of age. The program encompasses the ordering, distribution, and funding of vaccines for children all over the nation.
Over time, with expansion of the program, VFC grew into a sprawling supply chain. And, as with any complicated supply chain, product did not always flow smoothly to its destination. There were occasional problems with funding, supplies, storage, and delivery, any of which could stop the system cold. Managers of supply chains always worry about disruption. If there’s a hiccup in the system, it’s not just the flow of books, potato chips, or pajamas at stake, but the livelihood of everyone involved in the system. But that’s business. Consider the risk when a supply chain carrying vaccines is disrupted. Children’s lives are at stake.
Therefore, at the CDC, even a minor disruption of the VFC program was unacceptable. Thus, in 2003, the agency set out to revamp and strengthen the program. Now, five years later, it is rolling out the Vaccine Management Business Improvement Project (VMBIP), which promises to make programs like VFC more reliable, efficient, and transparent. The project has meant gargantuan change within the CDC and in public health agencies across the United States. From a business perspective, the new supply chain shares attributes of Wal-Mart Stores Inc., Amazon.com Inc., and the Social Security system. By employing best practices from a variety of successful organizations, VMBIP promises to save U.S. taxpayers hundreds of millions of dollars. “From a health-care perspective, the system’s highest purpose is very straightforward,” says Bill Gimson, the CDC’s chief operating officer. “Make it so that when doctors and nurses open up their refrigerators, the vaccine is there.”
Much depends on the success of VMBIP. If it can accomplish all its goals, VMBIP stands a good chance of becoming a blueprint for other federal health-care programs, and perhaps for other types of federal programs that distribute vast quantities of goods across the country, such as food programs and emergency relief. This business approach represents a shift within the CDC; its success will prove to skeptics that employing practices from the private sector can profoundly and effectively change the way government delivers goods and services.
