Evaluating accountability in the Vaccines for Children program: protecting a federal investment

The Vaccines for Children (VFC) program supplies health-care providers with federally purchased vaccines at no cost for administration to eligible children. Evaluation of vaccine accountability activities ensures appropriate and timely vaccinations are delivered. Program grantees in 50 states, Washington, five large U.S. metropolitan cities, and five U.S. territories and possessions completed a Web-based survey between December 2002 and January 2003 focused on current vaccine accountability operational systems. Most grantees required providers to complete profiles describing the vaccination needs and demographics of their practices. More than half requested providers use benchmarking data, doses-administered reports, and/or claims or encounter data to determine their VFC program-eligible population size; however, > 65% did not have written procedures for investigating and reconciling discrepancies between estimated vaccine needs and actual vaccine-use data. Most grantees had written standard policies requiring providers to report vaccine loss and wastage routinely and to explain why they occurred. Ninety percent of grantees did not have procedures to check providers for fraud and abuse sanctions, and 52% did not have written procedures to address complaints of vaccine fraud and abuse. These results suggested specific areas in which the Centers for Disease Control and Prevention should work with grantees to improve vaccine accountability practices. As a result, enhancements to the VFC program are being implemented to address these areas and their impact evaluated for their effectiveness in ensuring the continued success of the VFC program in protecting the nation's most vulnerable children and adolescents.