State health departments are facing federal budget cuts to programs that support childhood vaccination, which are coming at a time when immunization rates among children are slipping and under threat from anti-vaccine rhetoric.

News of the budget cuts was first reported by KFF Health News, which obtained a Centers for Disease Control and Prevention email dated June 27 that informed states of future funding reductions. The email, addressed to state immunization managers and signed by two CDC officials, said that the cuts will be “a significant change to your budget.”

“There will be no easy solution for this,” the CDC email read. “We know that this change will require some tough decisions.”

According to Claire Hannan, executive director of the Association of Immunization Managers (AIM), the budget cut eliminates federal funding specifically for the “immunization information systems” (IIS) program. In an interview with Ars, Hannan explained that the IIS basically supports immunization registries—systems that track vaccine doses administered. These data systems are also used to do things like pull up provider vaccine orders, run reports, and identify schools and zip codes where immunization rates are low.

The size of the budget reductions that states face is not yet entirely clear, Hannan said. Of 64 health jurisdictions, 44 have been in touch with AIM about the budget cuts. Those 44 jurisdictions reported that the loss of expected IIS funding would mean cuts ranging from 9.5 percent to 30 percent of the overall funding they were expecting for the grant year that began July 1. It amounts to a 10 percent to 37 percent reduction from what they actually received in the grant year that just ended.

“This is pretty unprecedented; it was completely unexpected,” Hannan said. Right now, “we have a lot of concerns,” she added, but state health departments don’t yet know their total grant award notifications, so it’s unclear if or how well they’ll be able to move money around to cover some of the support for these vital data systems. So far, “they’ve just been told ‘don’t expect this piece of your funding.” Hannan said.

In a comment to KFF Health News on Monday, CDC spokesperson Kristen Nordlund said, “The budgetary impact is still being worked out.” Nordlund did not immediately respond to a comment request from Ars.

One bright spot is that supplemental pandemic funding did lead to improvements in vaccination data systems, and some of that funding is still in effect through 2025, Hannan said. Still, it’s temporary, and the current funding cut hits core data systems. “It’s not just a concern for right now, it’s a concern about the future and really just the importance and the need to continuously invest in maintaining data systems and improving and enhancing them—and you can’t do that without funding,” she said.

Public health hazards

According to KFF, the CDC linked the cuts to the debt ceiling deal, which affected the federal immunization grant that was previously budgeted for $680 million. The deal, signed into law June 3 by President Biden to avert US default, included a variety of spending and policy provisions, one of which was to clawback around $27 billion in federal funding that had been appropriated, but not yet spent, for COVID-related programs. About half of that money will come from public health spending, according to Axios. But the exact programs facing cuts are not listed in the legislation.

Last month, CQ Roll Call reported that the CDC gave word to state health departments that the agency had slashed $400 million in funding from programs to combat sexually transmitted infections—a budget cut also linked to the debt ceiling deal. The funding cut comes as cases of STIs have been on the rise. Chlamydia, gonorrhea, and syphilis all increased between 2020 and 2021, the CDC reported in April. Syphilis cases, in particular, surged nearly 32 percent in just that year, with an alarming 32 percent rise in congenital syphilis, leading to 220 stillbirths and infant deaths in 2021.

The cuts to childhood vaccination data systems likewise fall during a worrisome period. Public health officials are wary of slipping vaccination rates amid the pandemic. The CDC reported in January that routine childhood vaccinations among kindergartners fell from 95 percent in the 2019-2020 school year to 93 percent in the 2021-2022 school year. The US has also seen a spat outbreaks and cases from vaccine-preventable diseases, namely measles and polio, in communities with low vaccination rates.

There’s also now a continual threat of entrenched anti-vaccine sentiment in the US. Though anti-vaccine groups and the vaccine-hesitant remain a slim minority in the country overall, dangerous anti-vaccine rhetoric gained prominence during the pandemic, fueling the spread of misinformation and distrust of COVID-19 vaccines. Recent research suggests that at least 232,000 deaths among unvaccinated people could have been prevented with primary vaccination.

Anti-vaccine advocates who stand to gain financially from undermining public trust in lifesaving immunizations are working to build on the talking points that went mainstream during the health crisis. One particularly prolific and dangerous anti-vaccine crusader, Robert F. Kennedy Jr., is now running for president as a Democrat. Although his campaign is not seen as a serious threat to an incumbent president, Kennedy is using his family name and campaign to elevate his conspiracy theories and misinformation, leading a columnist for the Los Angeles Times to label him a “walking public health hazard.”

Mark Del Monte, CEO of the American Academy of Pediatrics, told KFF: “Now is not the time to reduce federal support for routine childhood vaccine administration.”

https://arstechnica.com/?p=1951939