Military Health:

DOD's Vaccine Healthcare Centers Network

GAO-07-787R: Published: Jun 29, 2007. Publicly Released: Jun 29, 2007.

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Members of the military have long been required to receive immunizations. The Department of Defense (DOD) estimates that over 2.2 million servicemembers receive at least one mandatory immunization annually. Immunizations are provided through the administration of vaccines, which contain "antigens" or parts of a specific virus or bacterium that are used to trigger an immune response to protect the body from disease. DOD's immunization requirements vary depending on several factors, such as a servicemember's branch of military service, location, age, and type of personnel, such as newly enlisted recruits, those conducting high-risk travel, and reserve forces. No immunization is completely safe. Like all individuals, servicemembers may experience side-effects as a result of their immunizations, known as adverse events. Most adverse events consist of relatively mild reactions, such as swelling near the site of the immunization. However, a small number of individuals may experience more severe reactions, such as some servicemembers who received the anthrax and smallpox vaccines. Some servicemembers who received these vaccines experienced severe reactions such as migraines, heart problems, and the onset of diseases including diabetes and multiple sclerosis. Since then, the adverse events associated with these vaccines have caused concern among members of Congress about the safety of some mandatory immunizations. In response to three congressional directives, DOD established the Vaccine Healthcare Centers (VHC) Network in September 2001 with initial funding provided by the Department of Health and Human Services' (HHS) Centers for Disease Control and Prevention (CDC). The purpose of the VHC Network is to meet the health care needs of servicemembers receiving mandatory immunizations. DOD placed the VHC Network under the command of the Army Surgeon General. However, neither DOD nor the Army provided the VHC Network with a mission statement. As a result, VHC Network officials defined their own mission. In addition, since 2001, the VHC Network--which is not included in DOD's long-term budget planning--has relied upon funding provided on an annual basis from a variety of sources. Its lack of both a recognized mission and a specified funding source caused uncertainty among VHC Network officials about its future existence and organizational structure. Two recent laws--the National Defense Authorization Act for Fiscal Year 2006 and the National Defense Authorization Act for Fiscal Year 2007--contained provisions that required us to examine several issues related to the VHC Network. In response, and after consultation with the committees of jurisdiction, this report describes (1) the efforts the VHC Network is undertaking to address the needs of servicemembers arising from mandatory military immunizations and (2) how DOD has supported the mission of the VHC Network.

The VHC Network supports the health care needs of servicemembers that may arise from military immunizations in three ways. First, it offers clinical support. For example, it provides clinical care to servicemembers experiencing potential adverse events, and, in cases where the patient is not located near a regional VHC site, it may remotely coordinate the patient's care with the other providers directly involved in the patient's treatment. Second, the VHC Network conducts research to improve the safe administration of vaccines and the prevention, identification, and treatment of adverse events. Third, it educates servicemembers and military health care staff on adverse events. For example, the VHC Network makes information available by conducting briefings and posting training materials on a Web site. In general, DOD and CDC officials said that they consider the VHC Network's contributions important, particularly in the area of clinical care. However, several DOD officials, including DOD medical staff members, added that its educational efforts may not be reaching enough military health care providers who remain unaware, for example, of some adverse events and the role of the VHC Network. DOD's December 2006 decisions, including the plan to place the VHC Network under the command of the Military Vaccine Office (MILVAX), will give the VHC Network recognition as a formal entity within DOD's command structure and an established mission within DOD, and have the potential to provide access to a more stable source of funding, when they are implemented in fiscal year 2008. According to VHC Network officials, the absence of such a mission and a place in DOD's long-range budget has made it difficult to plan strategically, develop and maintain regional VHC sites, and attract and retain staff. Under DOD's new plan, the Army, Air Force, and Navy will each provide funding for the VHC Network. In addition, there will be opportunities for all the services to provide input into decisions regarding the activities of the VHC Network. VHC Network officials stated that they hope that DOD's decisions will provide opportunities for the VHC Network to plan for and accomplish its mission with greater predictability.

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