[House Report 117-179]
[From the U.S. Government Publishing Office]


117th Congress   }                                     {       Report
                        HOUSE OF REPRESENTATIVES
 1st Session     }                                     {      117-179

======================================================================



 
                        MATERNAL VACCINATION ACT

                                _______
                                

 November 30, 2021.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

 Mr. Pallone, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 951]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 951) to direct the Secretary of Health and Human 
Services to carry out a national campaign to increase awareness 
of the importance of maternal vaccinations for the health of 
pregnant and postpartum individuals and their children, and for 
other purposes, having considered the same, reports favorably 
thereon with an amendment and recommends that the bill as 
amended do pass.

                                CONTENTS

                                                                   Page
   I. Purpose and Summary.............................................2
  II. Background and Need for the Legislation.........................2
 III. Committee Hearings..............................................3
  IV. Committee Consideration.........................................4
   V. Committee Votes.................................................4
  VI. Oversight Findings..............................................4
 VII. New Budget Authority, Entitlement Authority, and Tax Expenditure4
VIII. Congressional Budget Office Estimate............................5
  IX. Federal Mandates Statement......................................5
   X. Statement of General Performance Goals and Objectives...........6
  XI. Duplication of Federal Programs.................................6
 XII. Committee Cost Estimate.........................................6
XIII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits.....6
 XIV. Advisory Committee Statement....................................6
  XV. Applicability to Legislative Branch.............................6
 XVI. Section-by-Section Analysis of the Legislation..................6
XVII. Changes in Existing Law Made by the Bill, as Reported...........7

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Maternal Vaccination Act''.

SEC. 2. MATERNAL VACCINATION AWARENESS AND EQUITY CAMPAIGN.

  (a) Campaign.--Section 313 of the Public Health Service Act (42 
U.S.C. 245) is amended--
          (1) in subsection (a), by inserting ``and among pregnant and 
        postpartum individuals,'' after ``low rates of vaccination,'';
          (2) in subsection (c)(3), by striking ``prenatal and 
        pediatric'' and inserting ``prenatal, obstetric, and 
        pediatric'';
          (3) in subsection (d)(4)(B), by inserting ``pregnant and 
        postpartum individuals and'' after ``including''; and
          (4) in subsection (g), by striking the dollar amount and 
        inserting ``$17,000,000''.
  (b) Additional Activities.--Section 317(k)(1)(E) of the Public Health 
Service Act (42 U.S.C. 247b(k)(1)(E)) is amended--
          (1) in clause (v), by striking ``and'' at the end; and
          (2) by adding at the end the following clause:
                  ``(vii) increase vaccination rates of pregnant and 
                postpartum individuals, including individuals from 
                racial and ethnic minority groups, and their children; 
                and''.

                         I. Purpose and Summary

    H.R. 951, the ``Maternal Vaccination Act,'' amends the 
Public Health Service Act (PHSA) to require the Secretary of 
Health and Human Services (the Secretary) to include outreach 
to obstetric care providers and improve efforts to increase 
vaccination among pregnant and postpartum individuals in 
vaccine public awareness campaigns. The bill also includes 
efforts to increase vaccination rates of pregnant and 
postpartum individuals as an authorized purpose for preventive 
health project grants authorized by the PHSA.

                II. Background and Need for Legislation

    Vaccinations for individuals during pregnancy can protect 
mothers and newborns against infectious diseases.\1\ Antibodies 
from vaccines have been shown to protect pregnant women and can 
be passed on to newborns, who may be too young to receive 
certain vaccines in the first several months of life.\2\ The 
Centers for Disease Control and Prevention (CDC) recommend that 
pregnant women receive the influenza vaccine and the tetanus 
toxoid, reduced diphtheria toxoid, and acellular pertussis 
vaccine (Tdap, also known as the whooping cough vaccine). CDC 
advises that both vaccines can protect mothers and newborns 
from complications of flu and pertussis, illnesses that can 
cause serious harm to patients, including early labor and 
delivery.\3\ CDC has also extended its recommendation for 
vaccination against coronavirus disease of 2019 (COVID-19) to 
all pregnant and breastfeeding individuals, citing growing 
evidence of the safety and efficacy of COVID-19 vaccination 
during pregnancy and the increased risk of severe illness from 
COVID-19 for pregnant individuals.\4\
---------------------------------------------------------------------------
    \1\U.S. Department of Health and Human Services, Vaccines for 
Pregnant Women, (https://www.hhs.gov/immunization/who-and-when/
pregnant/index.html).
    \2\Id.
    \3\Centers for Disease Control and Prevention, Why Maternal 
Vaccines Are Important, (https://www.cdc.gov/vaccines/pregnancy/hcp-
toolkit/important-maternal-vaccines.html).
    \4\Centers for Disease Control and Prevention, COVID-19 Vaccines 
While Pregnant or Breastfeeding, (https://www.cdc.gov/coronavirus/2019-
ncov/vaccines/recommendations/pregnancy.html).
---------------------------------------------------------------------------
    Despite longstanding recommendations for flu and Tdap 
vaccination, only 54.5 percent of pregnant individuals reported 
receiving a flu vaccine between October 2020 and January 2021, 
and 53.5 percent of pregnant individuals reported receiving 
Tdap vaccines.\5\ Only 30.7 percent of women with a recent live 
birth reported receiving both vaccines.\6\ Among these 
individuals, there were significant racial disparities. While 
33.3 percent of White women reported receiving both vaccines, 
only 17.7 percent of Black women reported receiving both 
vaccines.\7\ Other factors correlating with lower flu or Tdap 
vaccination rates included living below the federal poverty 
level, living in the South, being without prenatal insurance, 
and attaining lower levels of education.\8\
---------------------------------------------------------------------------
    \5\Centers for Disease Control and Prevention, Flu and Tdap 
Vaccination Coverage Among Pregnant Women--United States, April 2021, 
(https://www.cdc.gov/flu/fluvaxview/pregnant-women-apr2021.htm).
    \6\Id.
    \7\Id.
    \8\Id.
---------------------------------------------------------------------------
    The COVID-19 vaccine also has low uptake among pregnant 
individuals. According to recent data from CDC, only 31 percent 
of pregnant individuals have been vaccinated against COVID-19. 
Rates are lower among Latino pregnant individuals, 25 percent 
of whom have been vaccinated against COVID-19, and lower still 
among Black pregnant individuals, at only 15.6 percent.\9\
---------------------------------------------------------------------------
    \9\Centers for Disease Control and Prevention, CDC Statement on 
Pregnancy Health Advisory, (https://www.cdc.gov/media/releases/2021/
s0929-pregnancy-health-advisory.html).
---------------------------------------------------------------------------
    Care providers, especially obstetric care providers, have 
been shown to play an important role in ensuring pregnant 
individuals receive recommended vaccines. According to the 
American College of Obstetricians and Gynecologists, when a 
recommendation for vaccination comes directly from an obstetric 
care provider during pregnancy, the odds of vaccine acceptance 
and receipt are five-fold to 50-fold higher.\10\
---------------------------------------------------------------------------
    \10\American College of Obstetricians and Gynecologists, Committee 
Opinion on Maternal Immunization, (https://www.acog.org/clinical/
clinical-guidance/committee-opinion/articles/2018/06/maternal-
immunization).
---------------------------------------------------------------------------
    H.R. 951 aims to improve vaccination among pregnant and 
postpartum individuals by incorporating outreach to obstetric 
care providers and pregnant and postpartum individuals in 
existing federal vaccine awareness campaigns. The bill would 
also include efforts to vaccinate pregnant and postpartum 
individuals, including individuals from racial and ethnic 
minority groups, and their children, as an authorized purpose 
for prevention grants authorized by the Public Health Service 
Act.

                        III. Committee Hearings

    For the purposes of section 3(c) of rule XIII of the Rules 
of the House of Representatives, the following hearing was used 
to develop or consider H.R. 951:
    The Subcommittee on Health held a legislative hearing on 
June 15, 2021, entitled ``Booster Shot: Enhancing Public Health 
through Vaccine Legislation.'' The Subcommittee received 
testimony from the following witnesses:
           Phyllis Arthur, Vice President, Infectious 
        Diseases and Emerging Science Policy, Biotechnology 
        Innovation Organization;
           Rebecca Coyle, Executive Director, American 
        Immunization Registry Association;
           Yvonne Maldonado, M.D., Chair, Committee on 
        Infectious Diseases, American Academy of Pediatrics; 
        and
           Lijen (L.J.) Tan, Ph.D., Chief Strategy 
        Officer, Immunization Action Coalition.

                      IV. Committee Consideration

    H.R. 951, the ``Maternal Vaccination Act,'' was introduced 
on February 8, 2021, by Representative Terri Sewell (D-AL) 
along with 44 original cosponsors and referred to the Committee 
on Energy and Commerce. Subsequently, on February 9, 2021, H.R. 
951 was referred to the Subcommittee on Health. A legislative 
hearing was held on the bill on June 15, 2021.
    On July 15, 2021, the Subcommittee on Health met in open 
markup session, pursuant to notice, to consider H.R. 951 and 18 
other bills. During consideration of the bill, an amendment in 
the nature of a substitute (AINS) offered by Representative 
Barragan (D-CA) was agreed to by a voice vote. Upon conclusion 
of consideration of the bill, the Subcommittee on Health agreed 
to report the bill favorably to the full Committee, amended, by 
a voice vote.
    On July 21, 2021, the full Committee met in open markup 
session, pursuant to notice, to consider H.R. 951 and 23 other 
bills. No amendments were offered during consideration of the 
bill. Upon conclusion of consideration of the bill, the full 
Committee agreed to a motion on final passage offered by 
Representative Pallone (D-NJ), Chairman of the Committee, to 
order H.R. 951 reported favorably to the House, as amended, by 
a voice vote.

                           V. Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list each record vote 
on the motion to report legislation and amendments thereto. The 
Committee advises that there were no record votes taken on H.R. 
951.

                         VI. Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII and clause 2(b)(1) 
of rule X of the Rules of the House of Representatives, the 
oversight findings and recommendations of the Committee are 
reflected in the descriptive portion of the report.

 VII. New Budget Authority, Entitlement Authority, and Tax Expenditures

    Pursuant to 3(c)(2) of rule XIII of the Rules of the House 
of Representatives, the Committee adopts as its own the 
estimate of new budget authority, entitlement authority, or tax 
expenditures or revenues contained in the cost estimate 
prepared by the Director of the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974.

               VIII. Congressional Budget Office Estimate

                                     U.S. Congress,
                               Congressional Budget Office,
                                Washington, DC, September 21, 2021.
Hon. Frank Pallone Jr.,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 951, the Maternal 
Vaccination Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Sarah 
Sajewski.
            Sincerely,
                                         Phillip L. Swagel,
                                                          Director.
    Enclosure.

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    

    H.R. 951 would instruct the Centers for Disease Control and 
Prevention to broaden a public awareness campaign on 
vaccinations to include pregnant and postpartum individuals and 
require the campaign to disseminate vaccine information to 
providers and facilities that provide obstetric care. The bill 
would also authorize an additional $2 million annually from 
2021 through 2025 for the vaccination awareness campaign.
    For this estimate, CBO assumes H.R. 951 will be enacted 
near the beginning of fiscal year 2022. Based on historical 
spending for similar activities, CBO estimates that 
implementing H.R. 951 would increase federal spending by $7 
million over the 2022-2026 period, subject to the availability 
of appropriated funds.
    The CBO staff contact for this estimate is Sarah Sajewski. 
The estimate was reviewed by Leo Lex, Deputy Director of Budget 
Analysis.

                     IX. Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

        X. Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to support 
efforts to increase vaccination rates among pregnant and 
postpartum individuals and their children.

                  XI. Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 951 is known to be duplicative of another Federal program, 
including any program that was included in a report to Congress 
pursuant to section 21 of Public Law 111-139 or the most recent 
Catalog of Federal Domestic Assistance.

                      XII. Committee Cost Estimate

    Pursuant to clause 3(d)(1) of rule XIII, the Committee 
adopts as its own the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974.

   XIII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 951 contains no earmarks, limited tax 
benefits, or limited tariff benefits.

                   XIV. Advisory Committee Statement

    No advisory committee within the meaning of section 5(b) of 
the Federal Advisory Committee Act was created by this 
legislation.

                XIV. Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

           XV. Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 designates that the Act may be cited as the 
``Maternal Vaccination Act.''

Sec. 2. Maternal vaccination awareness and equity campaign

    Section 2 amends Section 313 of the PHSA, relating to a 
public awareness campaign on the importance of vaccinations, to 
direct the Secretary to incorporate efforts directed toward 
pregnant and postpartum individuals into such campaign.
    Section 2 further amends PHSA section 313 by requiring the 
Secretary to disseminate information to obstetric care 
providers and authorizing the Secretary to directly disseminate 
scientific and evidence-based vaccine-related information to 
pregnant and postpartum individuals.
    Additionally, section 2 amends PHSA section 317(k), 
relating to grants for addressing vaccine-preventable diseases, 
to include efforts to increase vaccination rates among 
postpartum individuals, including individuals from racial and 
ethnic minority groups, and their children, as an authorized 
purpose of such grants.
    To account for increased activities authorized by the 
Maternal Vaccination Act, section 2 increases the authorization 
for PHSA sections 313, 317(k), and 317(n) related to 
vaccination data from $15 million annually to $17 million 
annually for each of fiscal years 2021 through 2025.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, and existing law in which no 
change is proposed is shown in roman):

                       PUBLIC HEALTH SERVICE ACT




           *       *       *       *       *       *       *
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

           *       *       *       *       *       *       *



Part B--Federal-State Cooperation

           *       *       *       *       *       *       *



SEC. 313. PUBLIC AWARENESS CAMPAIGN ON THE IMPORTANCE OF VACCINATIONS.

  (a) In General.--The Secretary, acting through the Director 
of the Centers for Disease Control and Prevention and in 
coordination with other offices and agencies, as appropriate, 
shall award competitive grants or contracts to one or more 
public or private entities to carry out a national, evidence-
based campaign to increase awareness and knowledge of the 
safety and effectiveness of vaccines for the prevention and 
control of diseases, combat misinformation about vaccines, and 
disseminate scientific and evidence-based vaccine-related 
information, with the goal of increasing rates of vaccination 
across all ages, as applicable, particularly in communities 
with low rates of vaccination, and among pregnant and 
postpartum individuals, to reduce and eliminate vaccine-
preventable diseases.
  (b) Consultation.--In carrying out the campaign under this 
section, the Secretary shall consult with appropriate public 
health and medical experts, including the National Academy of 
Medicine and medical and public health associations and 
nonprofit organizations, in the development, implementation, 
and evaluation of the evidence-based public awareness campaign.
  (c) Requirements.--The campaign under this section shall--
          (1) be a nationwide, evidence-based media and public 
        engagement initiative;
          (2) include the development of resources for 
        communities with low rates of vaccination, including 
        culturally and linguistically appropriate resources, as 
        applicable;
          (3) include the dissemination of vaccine information 
        and communication resources to public health 
        departments, health care providers, and health care 
        facilities, including such providers and facilities 
        that provide [prenatal and pediatric] prenatal, 
        obstetric, and pediatric care;
          (4) be complementary to, and coordinated with, any 
        other Federal, State, local, or Tribal efforts, as 
        appropriate; and
          (5) assess the effectiveness of communication 
        strategies to increase rates of vaccination.
  (d) Additional Activities.--The campaign under this section 
may--
          (1) include the use of television, radio, the 
        internet, and other media and telecommunications 
        technologies;
          (2) include the use of in-person activities;
          (3) be focused to address specific needs of 
        communities and populations with low rates of 
        vaccination; and
          (4) include the dissemination of scientific and 
        evidence-based vaccine-related information, such as--
                  (A) advancements in evidence-based research 
                related to diseases that may be prevented by 
                vaccines and vaccine development;
                  (B) information on vaccinations for 
                individuals and communities, including pregnant 
                and postpartum individuals and individuals for 
                whom vaccines are not recommended by the 
                Advisory Committee for Immunization Practices, 
                and the effects of low vaccination rates within 
                a community on such individuals;
                  (C) information on diseases that may be 
                prevented by vaccines; and
                  (D) information on vaccine safety and the 
                systems in place to monitor vaccine safety.
  (e) Evaluation.--The Secretary shall--
          (1) establish benchmarks and metrics to 
        quantitatively measure and evaluate the awareness 
        campaign under this section;
          (2) conduct qualitative assessments regarding the 
        awareness campaign under this section; and
          (3) prepare and submit to the Committee on Health, 
        Education, Labor, and Pensions of the Senate and 
        Committee on Energy and Commerce of the House of 
        Representatives an evaluation of the awareness campaign 
        under this section.
  (f) Supplement Not Supplant.--Funds appropriated under this 
section shall be used to supplement and not supplant other 
Federal, State, and local public funds provided for activities 
described in this section.
  (g) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section and subsections (k) 
and (n) of section 317, [$15,000,000] $17,000,000 for each of 
fiscal years 2021 through 2025.

           *       *       *       *       *       *       *


             project grants for preventive health services

  Sec. 317. (a) The Secretary may make grants to States, and in 
consultation with State health authorities, to political 
subdivisions of States and to other public entities to assist 
them in meeting the costs of establishing and maintaining 
preventive health service programs.
  (b) No grant may be made under subsection (a) unless an 
application therefor has been submitted to, and approved by, 
the Secretary. Such an application shall be in such form and be 
submitted in such manner as the Secretary shall by regulation 
prescribe and shall provide--
          (1) a complete description of the type and extent of 
        the program for which the applicant is seeking a grant 
        under subsection (a);
          (2) with respect to each such program (A) the amount 
        of Federal, State, and other funds obligated by the 
        applicant in its latest annual accounting period for 
        the provision of such program, (B) a description of the 
        services provided by the applicant in such program in 
        such period, (C) the amount of Federal funds needed by 
        the applicant to continue providing such services in 
        such program, and (D) if the applicant proposes changes 
        in the provision of the services in such program, the 
        priorities of such proposed changes, reasons for such 
        changes, and the amount of Federal funds needed by the 
        applicant to make such changes;
          (3) assurances satisfactory to the Secretary that the 
        program which will be provided with funds under a grant 
        under subsection (a) will be provided in a manner 
        consistent with the State health plan in effect under 
        section 1524(c) and in those cases where the applicant 
        is a State, that such program will be provided, where 
        appropriate, in a manner consistent with any plans in 
        effect under an application approved under section 315;
          (4) assurances satisfactory to the Secretary that the 
        applicant will provide for such fiscal control and fund 
        accounting procedures as the Secretary by regulation 
        prescribes to assure the proper disbursement of and 
        accounting for funds received under grants under 
        subsection (a);
          (5) assurances satisfactory to the Secretary that the 
        applicant will provide for periodic evaluation of its 
        program or programs;
          (6) assurances satisfactory to the Secretary that the 
        applicant will make such reports (in such form and 
        containing such information as the Secretary may by 
        regulation prescribe) as the Secretary may reasonably 
        require and keep such records and afford such access 
        thereto as the Secretary may find necessary to assure 
        the correctness of, and to verify, such reports;
          (7) assurances satisfactory to the Secretary that the 
        applicant will comply with any other conditions imposed 
        by this section with respect to grants; and
          (8) such other information as the Secretary may by 
        regulation prescribe.
  (c)(1) The Secretary shall not approve an application 
submitted under subsection (b) for a grant for a program for 
which a grant was previously made under subsection (a) unless 
the Secretary determines--
          (A) the program for which the application was 
        submitted is operating effectively to achieve its 
        stated purpose,
          (B) the applicant complied with the assurances 
        provided the Secretary when applying for such previous 
        grant, and
          (C) the applicant will comply with the assurances 
        provided with the application.
  (2) The Secretary shall review annually the activities 
undertaken by each recipient of a grant under subsection (a) to 
determine if the program assisted by such grant is operating 
effectively to achieve its stated purposes and if the recipient 
is in compliance with the assurances provided the Secretary 
when applying for such grant.
  (d) The amount of a grant under subsection (a) shall be 
determined by the Secretary. Payments under such grants may be 
made in advance on the basis of estimates or by the way of 
reimbursement, with necessary adjustments on account of 
underpayments or overpayments, and in such installments and on 
such terms and conditions as the Secretary finds necessary to 
carry out the purposes of such grants.
  (e) The Secretary, at the request of a recipient of a grant 
under subsection (a), may reduce the amount of such grant by--
          (1) the fair market value of any supplies (including 
        vaccines and other preventive agents) or equipment 
        furnished the grant recipient, and
          (2) the amount of the pay, allowances, and travel 
        expenses of any officer or employee of the Government 
        when detailed to the grant recipient and the amount of 
        any other costs incurred in connection with the detail 
        of such officer or employee.
When the furnishing of such supplies or equipment or the detail 
of such an officer or employee is for the convenience of and at 
the request of such grant recipient and for the purpose of 
carrying out a program with respect to which the grant under 
subsection (a) is made. The amount by which any such grant is 
so reduced shall be available for payment by the Secretary of 
the costs incurred in furnishing the supplies or equipment, or 
in detailing the personnel, on which the reduction of such 
grant is based, and such amount shall be deemed as part of the 
grant and shall be deemed to have been paid to the grant 
recipient.
  (f)(1) Each recipient of a grant under subsection (a) shall 
keep such records as the Secretary shall by regulation 
prescribe, including records which fully disclose the amount 
and disposition by such recipient of the proceeds of such 
grant, the total cost of the undertaking in connection with 
which such grant was made, and the amount of that portion of 
the cost of the undertaking supplied by other sources, and such 
other records as will facilitate an effective audit.
  (2) The Secretary and the Comptroller General of the United 
States, or any of their duly authorized representatives, shall 
have access for the purpose of audit and examination to any 
books, documents, papers, and records of the recipient of 
grants under subsection (a) that are pertinent to such grants.
  (g)(1) Nothing in this section shall limit or otherwise 
restrict the use of funds which are granted to a State or to an 
agency or a political subdivision of a State under provisions 
of Federal law (other than this section) and which are 
available for the conduct of preventive health service programs 
from being used on connection with programs assisted through 
grants under subsection (a).
  (2) Nothing in this section shall be construed to require any 
State or any agency or political subdivision of a State to have 
a preventive health service program which would require any 
person, who objects to any treatment provided under such a 
program, to be treated or to have any child or ward treated 
under such program.
  (h) The Secretary shall include, as part of the report 
required by section 1705, a report on the extent of the 
problems presented by the diseases and conditions referred to 
in subsection (j) on the amount of funds obligated under grants 
under subsection (a) in the preceding fiscal year for each of 
the programs listed in subsection (j); and on the effectiveness 
of the activities assisted under grants under subsection (a) in 
controlling such diseases and conditions.
  (i) The Secretary may provide technical assistance to States, 
State health authorities, and other public entities in 
connection with the operation of their preventive health 
service programs.
  (j)(1) Except for grants for immunization programs the 
authorization of appropriations for which are established in 
paragraph (2), for grants under subsections (a) and (k)(1) for 
preventive health service programs to immunize without charge 
children, adolescents, and adults against vaccine-preventable 
diseases, there are authorized to be appropriated such sums as 
may be necessary. Not more than 10 percent ot the total amount 
appropriated under the preceding sentence for any fiscal year 
shall be available for grants under subsection (k)(1) for such 
fiscal year.
  (2) For grants under subsection (a) for preventive health 
service programs for the provision without charge of 
immunizations with vaccines approved for use, and recommended 
for routine use, there are authorized to be appropriated such 
sums as may be necessary.
  (k)(1) The Secretary may make grants to States, political 
subdivisions of States, and other public and nonprofit private 
entities for--
          (A) research into the prevention and control of 
        diseases that may be prevented through vaccination;
          (B) demonstration projects for the prevention and 
        control of such diseases;
          (C) public information and education programs for the 
        prevention and control of such diseases;
          (D) education, training, and clinical skills 
        improvement activities in the prevention and control of 
        such diseases for health professionals (including 
        allied health personnel);
          (E) planning, implementation, and evaluation of 
        activities to address vaccine-preventable diseases, 
        including activities to--
                  (i) identify communities at high risk of 
                outbreaks related to vaccine-preventable 
                diseases, including through improved data 
                collection and analysis;
                  (ii) pilot innovative approaches to improve 
                vaccination rates in communities and among 
                populations with low rates of vaccination;
                  (iii) reduce barriers to accessing vaccines 
                and evidence-based information about the health 
                effects of vaccines;
                  (iv) partner with community organizations and 
                health care providers to develop and deliver 
                evidence-based interventions, including 
                culturally and linguistically appropriate 
                interventions, to increase vaccination rates;
                  (v) improve delivery of evidence-based 
                vaccine-related information to parents and 
                others; [and]
                  (vi) improve the ability of State, local, 
                Tribal, and territorial public health 
                departments to engage communities at high risk 
                for outbreaks related to vaccine-preventable 
                diseases, including, as appropriate, with local 
                educational agencies, as defined in section 
                8101 of the Elementary and Secondary Education 
                Act of 1965; and
                  (vii) increase vaccination rates of pregnant 
                and postpartum individuals, including 
                individuals from racial and ethnic minority 
                groups, and their children; and
          (F) research related to strategies for improving 
        awareness of scientific and evidence-based vaccine-
        related information, including for communities with low 
        rates of vaccination, in order to understand barriers 
        to vaccination, improve vaccination rates, and assess 
        the public health outcomes of such strategies.
  (2) The Secretary may make grants to States, political 
subdivisions of States, and other public and nonprofit private 
entities for--
          (A) research into the prevention and control of 
        diseases and conditions;
          (B) demonstration projects for the prevention and 
        control of such diseases and conditions;
          (C) public information and education programs for the 
        prevention and control of such diseases and conditions; 
        and
          (D) education, training, and clinical skills 
        improvement activities in the prevention and control of 
        such diseases and conditions for health professionals 
        (including allied health personnel).
  (3) No grant may be made under this subsection unless an 
application therefor is submitted to the Secretary in such 
form, at such time, and containing such information as the 
Secretary may by regulation prescribe.
  (4) Subsections (d), (e), and (f) shall apply to grants under 
this subsection in the same manner as such subsections apply to 
grants under subsection (a).
  (l) Authority to Purchase Recommended Vaccines for Adults.--
          (1) In general.--The Secretary may negotiate and 
        enter into contracts with manufacturers of vaccines for 
        the purchase and delivery of vaccines for adults as 
        provided for under subsection (e).
          (2) State purchase.--A State may obtain additional 
        quantities of such adult vaccines (subject to amounts 
        specified to the Secretary by the State in advance of 
        negotiations) through the purchase of vaccines from 
        manufacturers at the applicable price negotiated by the 
        Secretary under this subsection.
  (m) Demonstration Program To Improve Immunization Coverage.--
          (1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and 
        Prevention, shall establish a demonstration program to 
        award grants to States to improve the provision of 
        recommended immunizations for children, adolescents, 
        and adults through the use of evidence-based, 
        population-based interventions for high-risk 
        populations.
          (2) State plan.--To be eligible for a grant under 
        paragraph (1), a State shall submit to the Secretary an 
        application at such time, in such manner, and 
        containing such information as the Secretary may 
        require, including a State plan that describes the 
        interventions to be implemented under the grant and how 
        such interventions match with local needs and 
        capabilities, as determined through consultation with 
        local authorities.
          (3) Use of funds.--Funds received under a grant under 
        this subsection shall be used to implement 
        interventions that are recommended by the Task Force on 
        Community Preventive Services (as established by the 
        Secretary, acting through the Director of the Centers 
        for Disease Control and Prevention) or other evidence-
        based interventions, including--
                  (A) providing immunization reminders or 
                recalls for target populations of clients, 
                patients, and consumers;
                  (B) educating targeted populations and health 
                care providers concerning immunizations in 
                combination with one or more other 
                interventions;
                  (C) reducing out-of-pocket costs for families 
                for vaccines and their administration;
                  (D) carrying out immunization-promoting 
                strategies for participants or clients of 
                public programs, including assessments of 
                immunization status, referrals to health care 
                providers, education, provision of on-site 
                immunizations, or incentives for immunization;
                  (E) providing for home visits that promote 
                immunization through education, assessments of 
                need, referrals, provision of immunizations, or 
                other services;
                  (F) providing reminders or recalls for 
                immunization providers;
                  (G) conducting assessments of, and providing 
                feedback to, immunization providers;
                  (H) any combination of one or more 
                interventions described in this paragraph; or
                  (I) immunization information systems to allow 
                all States to have electronic databases for 
                immunization records.
          (4) Consideration.--In awarding grants under this 
        subsection, the Secretary shall consider any reviews or 
        recommendations of the Task Force on Community 
        Preventive Services.
          (5) Evaluation.--Not later than 3 years after the 
        date on which a State receives a grant under this 
        subsection, the State shall submit to the Secretary an 
        evaluation of progress made toward improving 
        immunization coverage rates among high-risk populations 
        within the State.
          (6) Report to congress.--Not later than 4 years after 
        the date of enactment of the Affordable Health Choices 
        Act, the Secretary shall submit to Congress a report 
        concerning the effectiveness of the demonstration 
        program established under this subsection together with 
        recommendations on whether to continue and expand such 
        program.
          (7) Authorization of appropriations.--There is 
        authorized to be appropriated to carry out this 
        subsection, such sums as may be necessary for each of 
        fiscal years 2010 through 2014.
  (n) Vaccination Data.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, 
shall expand and enhance, and, as appropriate, establish and 
improve, programs and conduct activities to collect, monitor, 
and analyze vaccination coverage data to assess levels of 
protection from vaccine-preventable diseases, including by 
assessing factors contributing to underutilization of vaccines 
and variations of such factors, and identifying communities at 
high risk of outbreaks associated with vaccine-preventable 
diseases.

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