A recent report from the CDC found Arizona has among the lowest childhood vaccination rates in the U.S. (as measured by school vaccine exemption rates). There are many reasons why vaccination rates can be poor. Part of it can be attributed to parental vaccine hesitancy & the anti-vax movement. Some are related to policy decisions. For example, states that only allow medical exemptions to school attendance requirements (no ‘personal exemptions’) have higher vaccination rates than those that allow for personal exemptions (like Arizona).

But much of it can be attributed to how easy or difficult it is for parents to vaccinate their kids. The more difficult/inconvenient it is to get your child vaccinated the more likely it is that they’ll remain unvaccinated.

Sadly, it’s been getting harder and harder for parents to get their kids vaccinated in Arizona because so many doctor’s offices dropped out of the Vaccines for Children program, leaving parents scrambling to get their kids vaccinated.

The Vaccines for Children Program exists to make it convenient for families to get their kids vaccinated and to make sure kids whose parents don’t have health insurance can still get their kids vaccinated. Funding for VFC comes via the CDC, who buys vaccines at a discount and distributes them to states. States distribute them to physicians’ offices & clinics that take part in the VFC program. ADHS manages the VFC program in our state.

So how good of a job has Arizona been doing implementing the VFC program? Not very good. Arizona lost 50% of its VFC providers during the Ducey administration – going from 1,200 to 600… reducing access to vaccine and lowering childhood vaccination rates.

Arizona now only has 6 VFC providers per 10,000 Medicaid eligible kids, while the national average is 24 providers per 10,000 Medicaid kids… meaning Arizona only has 25% of the number of VFC providers per Medicaid enrolled kid compared with the national average.

Why the Decline?

Providers who left VFC over the last few years have anecdotally said they quit because of the administrative hassles imposed on them by the state over the last 8 years. At the top of the list of grievances is ADHS’ punitive practice of financially punishing providers who have discrepancies in their vaccine inventories.

Stakeholders from several organizations including AZPHA had been pressing ADHS’ Vaccine for Children program to make policy, regulation, and tone adjustments over the last several years, to no avail.

Finally, the Maricopa County Department of Public Health contracted with The Arizona Partnership for Immunizations to study this issue and prepare a report describing the facilitators and challenges to participating in the VFC program from healthcare providers’ perspectives, as well as recommendations for reversing this course. TAPI hired OMNI Institute, a social sciences non-profit consultancy to conduct this assessment.

That report, entitled An Assessment of the Facilitators & Challenges Providing-Vaccine in Arizona was released Monday evening. The 96-page report has many findings. A common theme as presented in the Executive Summary:

“Respondents expressed frustration with the complexity surrounding ordering and returning vaccines, the challenges integrating practice electronic medical record systems with the Arizona State Immunization Information System and the administrative burdens regarding compliance and reconciliation.”

“When asked about the significant challenges/barriers to their continued participation in the VFC program, a common theme respondents raised was an adversarial tone in the enforcement of VFC policies and communications, with administrative errors (some of which stemmed from ASIIS) often being met with accusations of fraud and/or wastage. Many non-VFC providers pointed to administrative burdens, expensive charges to rectify incorrect dose counts, and a generally punitive tone from the VFC program as rationales for their non-participation.”

Read the Report

The response from MCDPH Director, Marcy Flanagan, painted an optimistic assessment of the chances that ADHS will implement some of the recommendations in the report:

“The results of this assessment help to paint a picture of opportunity. Opportunity to look at each spoke in this very complicated vaccine delivery system and address how it could be done more efficiently and effectively for all parties involved. With so many of the spokes leading to federal and state regulation, it made sense that many of the recommendations cited in the report looked at system improvements.

“In the spirit of continuous quality improvement, MCDPH leadership sat down and talked with the Arizona Department of Health Services leadership about this assessment and potential areas of improvement. ADHS listened intently and asked questions as we explained concerns cited in the report. They agreed that a deeper dive into the system and the policies that make up the system made sense. In fact, an immediate response from ADHS was to host a working group made up of providers and partners to dig into some of the challenges brought forth in this report. This is a great first step.”

The next several weeks will be critical. ADHS is in the process of hiring a new leader for their Immunizations program. The quality and professional outlook of the candidate they hire will be critical to implementing the recommendations in the report.

The ADHS Director/CEO has also promised to “… convene a workgroup of providers and partners to review current policies and practices and collaboratively determine changes to improve the provider experience within the program.” Interested parties can contact the Director’s Office at andrea.schoenecker@azdhs.gov.

As for the dose-for-dose restitution policy at the core of many of the findings in the report…  ADHS says they don’t intend to enforce the policy while they: ”…work with partners on the best approach to vaccine management.” The policy will nevertheless stay on the books while it’s enforcement will be ‘paused’ – even though CDC’s official Operational Guide DOES NOT require states to have a vaccine restitution policy.  See Page 80-86 of CDC’ VFC Operations Guide 2023 

As for me…  I’m reminded of the old proverb: “Trust, but verify.”


New CDC Report: Arizona Has Among the Lowest Childhood Immunization Rates in the U.S.

AZ Vaccine Congress Meets RE Plummeting Provider Participation in the Vaccines for Children Program 

AZ Childhood Vaccination Rates Declined During the Ducey Administration: Is it Bad Luck or Bad Policy & Management?

Righting Arizona’s ‘Vaccines for Children’ Ship