The Impact of ACIP Permissive Recommendation on State, Local and Territorial Immunization Programs

Background:The Association of Immunization Managers (AIM) conducted a survey of Immunization Program Managers (IPMs) aimed at assessing the impact of Advisory Committee on Immunization Practices (ACIP) permissive recommendation on State, Local and Territorial Immunization Programs (IP). In a survey of IPMs, the ACIP permissive recommendation for HPV in males, made in October 2009, was used as a case study. 

Objectives:Investigate the programmatic impact of ACIP permissive recommendations on IP.

Methods:The survey was administered via survey monkey to IPMs in June 2010. 

Results: Sixty-one percent (39/64) of IPMs responded to the survey. Most common interpretation of permissive recommendations were that there is not adequate data to recommend the vaccine as part of the routine schedule (53%), and that it is not cost effective to routinely vaccinate males (50%). In response to the ACIP permissive recommendation for HPV in males, 92% of respondents requested additional VFC funds and 69% increased provider’s HPV vaccine allocation, but fewer used 317 or 317 ARRA funds for this purpose (16% and 23%, respectively). While vaccine was commonly provided for VFC/underinsured children in public settings (64%), only 36% respondents provided this vaccine for VFC/underinsured children in private settings. Thirty percent of respondents promoted the vaccine the same as if there was a routine ACIP recommendation, and 65% indicated vaccine was made available for providers but was not promoted by the IP. Forty-one percent of respondents reported that providers made permissive recommended vaccine available but did not encourage patients to be vaccinated.

Conclusions: There is variation between how IP interpret ACIP permissive recommendations. In response to the ACIP permissive recommendation for HPV in males, most IP requested more VFC funds and made vaccine available to providers, but many IP and providers did not encourage or promote vaccination. ACIP permissive recommendations may result in the target group not being vaccinated even if vaccine is available.