FY 2022 Annual Performance Plan and Report - Goal 2 Objective 2

Fiscal Year 2022
Released June, 2021

Topics on this page: Goal 2. Objective 2 | Objective 2.2 Table of Related Performance Measures

Goal 2. Objective 2: Prevent, treat, and control communicable diseases and chronic conditions

Communicable diseases and chronic conditions affect the lives of millions of Americans every day.  The emergence and spread of infectious diseases—such as HIV/AIDS, hepatitis, tuberculosis, measles, and human papillomavirus—can quickly threaten the stability of public health for communities and place whole populations at risk.  The rise of globalization and ease of travel also has made it easier for domestic and international outbreaks—including COVID-19 as well as recent outbreaks of measles, pandemic influenza A, Ebola, Zika, and chikungunya—to create public health challenges.  Moreover, the prevalence of chronic conditions—such as diabetes, heart disease, stroke, and cancer—in the United States continues to contribute to the daily struggles of Americans.  The occurrence of multiple chronic conditions also exacerbates the adverse health impacts and health care costs associated with chronic conditions and their associated health risks.  HHS programs and initiatives focus on promoting partnerships, educating the public, improving vaccine development and uptake, advancing early detection and prevention methods, and enhancing surveillance and response capacity.

In the previous administration, the Office of the Secretary led this objective.  The following divisions are responsible for implementing programs under this strategic objective: ACL, ASPA, ASPR, CDC, CMS, FDA, HRSA, IHS, NIH, OASH, OGA, and SAMHSA.  HHS has determined that performance toward this objective is progressing.  The narrative below provides a brief summary of progress made and achievements or challenges, as well as plans to improve or maintain performance.

Objective 2.2 Table of Related Performance Measures

Increase the percentage of Ryan White HIV/AIDS Program clients receiving HIV medical care and at least one viral load test who are virally suppressed (Lead Agency - HRSA; Measure ID - 16.III.A.4)

Measure FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021 FY 2022
Target N/A N/A N/A 83% 83% 83% 83% 83%
Result 83% 85% 86% 87% 88% 10/31/22 10/31/23 10/31/24
Status Actual Actual Actual Target Exceeded Target Exceeded Pending Pending Pending

The Ryan White HIV/AIDS Program (RWHAP) works to improve health outcomes by preventing disease transmission or slowing disease progression for disproportionately impacted communities.  One way RWHAP accomplishes its mission is through the provision of medications that help patients reach HIV viral suppression.  People living with HIV who use medications designed to virally suppress the disease are less infectious, which reduces the risk of their transmitting HIV to others.  In FY 2021 and FY 2022, RWHAP will continue to play a central role in ending the HIV epidemic by ensuring that persons living with HIV have access to regular care, receive antiretroviral medications, and adhere to a regular schedule for taking their medications.  The percentage of RWHAP clients who are virally suppressed currently exceeds the national average.  Because the Ending the HIV Epidemic Initiative will introduce people with low rates of viral suppression into the Ryan White HIV/AIDS Program and because the impact of COVID-19 on viral suppression is not yet known, HRSA is maintaining this target.

Increase the percentage of adults aged 18 years and older who are vaccinated annually against seasonal influenza (Lead Agency - CDC; Measure ID - 1.3.3a)

Measure FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021 FY 2022
Target 53% 56% 59% 62% 66% 70% 70% 70%
Result 42% 43% 38% 45.3% 48% 9/30/21 9/30/22 9/30/23
Status Target Not Met Target Not Met but Improved Target Not Met Target Not Met but Improved Target Not Met but Improved Pending Pending Pending

In the United States, on average 5 to 20 percent of the population contracts the flu, more than 200,000 people are hospitalized from seasonal flu-related complications, and approximately 36,000 people die from seasonal flu-related causes.  This measure reflects the universal influenza vaccination recommendation and aligns with the Advisory Committee on Immunization Practices' updated recommendation (as of 2010) for the seasonal influenza vaccine.  Seasonal influenza vaccination rates for adults aged 18 and older increased from 38 percent in FY 2017 to 48 percent in FY 2019.   Interpretation of these results should take into account limitations of the survey, which include reliance on self-reporting of vaccination status and a decrease in response rates.  Preliminary estimates from claims-based data systems showed no decreases in flu vaccination coverage.  Four in ten adults report receiving a flu vaccination.  In FY 2021 and FY 2022, CDC will continue to monitor the percentage of adults aged 18 and older who receive annual are vaccination  against seasonal influenza to inform its strategies for improving adult vaccination coverage rates.

While the most recent data shows improvement, flu vaccination coverage among adults remains at about 4 in 10 adults reporting receipt of a flu vaccination.

CDC's continuing efforts to improve adult vaccination coverage rates include:

  • Increasing patient and provider education to improve demand and implement system changes in practitioner office settings to reduce missed opportunities for vaccinations.
  • Funding state and local health departments to implement the Standards for Adult Immunization Practice in large health care systems, community health centers, pharmacies, and other settings.
  • Partnering with professional organizations (e.g., F1.3 American Pharmacists Association, American College of Physicians, American Academy of Family Physicians, American College of Obstetricians and Gynecologists) and other organizations (e.g., National Association of Chain Drug Stores, National Association of Community Health Centers, American Immunization Registry Association) to develop and implement strategies to improve adult immunization at provider, practice, and systems levels.
  • Enhancing evidence-based communication campaigns to increase public awareness about adult vaccines and recommendations.  CDC routinely conducts literature reviews and surveys of the general public and health care providers to provide a deeper understanding of the target audiences for development of adult immunization communication messages and campaigns.
  • Partnering with the National Adult and Influenza Immunization Summit, a national coalition of partners and stakeholders represented by clinicians, public health, industry, government, and other entities with the common goal to promote immunization for adults.
  • Expanding the reach of vaccination programs including new venues such as pharmacies and other retail clinics.  CDC has existing partnerships to implement adult immunization practice standards, HPV vaccination, and pandemic vaccine program planning efforts to expand access to pandemic vaccine.  As of 2016-2017 influenza season, nearly one in four adults who got an influenza vaccine were vaccinated in a pharmacy or retail setting.
  • Designing and funding investigations into the factors associated with disparities in adult vaccination among racial and ethnic minority populations and projects designed to expand the evidence base for interventions to increase vaccination among adults with chronic medical conditions and underserved populations.
  • Engaging 18 subject matter experts with deep expertise in addressing health disparities and representing a broad array of disciplines to provide input on the development of concrete, scalable, and sustainable interventions that may begin to reduce disparities in adult vaccination in the African American community.
  • Purchasing 9.3 million additional doses directly from vaccine manufacturers to help uninsured and under-insured adult Americans get their flu vaccines, especially those at higher risk.
  • Collaborating with numerous existing and new partners to expand flu vaccine coverage, with specific efforts to address racial and ethnic disparities for the 2020-2021 influenza season.  For example, CDC is working with the National Association for Community Health Centers to implement evidence-based strategies to increase adult vaccination coverage among underserved priority populations.  CDC has developed new partnerships to promote flu vaccination in high-risk populations (cardiovascular, diabetes, chronic lung conditions, etc.) and those in congregate settings (i.e., long-term care facilities, homeless shelters, and prisons).  The work to promote flu vaccination will help pave the way for COVID-19 vaccination in these same at-risk groups.

Continue advanced research and development initiatives for more effective influenza vaccines and the development of safe and broad-spectrum therapeutics for use in seriously ill and/or hospitalized patients, including pediatric patients (Lead Agency - ASPR; Measure ID - 2.4.15b)

Measure FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021 FY 2022
Target N/A N/A Baseline 2 2 2 2 2
Result N/A N/A 2 7 6 2 12/31/21 12/31/22
Status N/A N/A Actual Target Exceeded Target Exceeded Target Met Pending Pending

Illness caused by influenza and other pathogens, including SARS-CoV-2 (severe acute respiratory syndrome coronavirus), can evolve, spread geographically, and infect large numbers of people quickly.  In addition to the annual toll taken by seasonal influenza, hundreds of thousands of people could be hospitalized with influenza in the US during a severe pandemic.  ASPR is improving the Nation's seasonal and pandemic influenza prevention and treatment options by a) expanding and maintaining the number of influenza vaccine options and domestic manufacturing capability of those vaccines; b) developing new vaccines with broader protection and faster production time; and c) supporting development and broadening indications for influenza therapeutics.  This has included licensing of the first two non-egg based platforms, as well as the first two pre-pandemic influenza vaccines, and an antiviral to treat influenza infection.  However, an average of over 36,000 Americans still die annually from influenza, influenza vaccine efficacy rates still fluctuate seasons to season and are not as high as desired, and there are no treatments for hospitalized patients.  Finally, as re-inforced by the COVID-19 experience, vaccine production and availability must be faster than current capabilities.  In FY 2020, efforts to address these gaps continued in parallel with funding efforts to maintain current capabilities.  Specifically, BARDA made awards to significantly expand domestic production of the recombinant influenza vaccine and adjuvant, and address alternative (non-needle/syringe) administration approaches.

During FY 2021 and FY 2022, key components of ASPR's strategy is to further accelerate vaccine production capability, improve vaccine efficacy, and develop formulations that will enable increased vaccine uptake.  To do this, ASPR continues to support improvements on current vaccine platforms, such as development of adjuvanted vaccines, as well as development of new, more rapid platforms that may also have better efficacy.  Efforts will also be made to identify new therapeutic targets to treat hospitalized patients.

HHS FY 2020-2021 Agency Priority Goals

The HHS FY 2020-2021 APGs established by the previous administration supported multiple objectives across the HHS Strategic Plan.  For presentation purposes, the Department has chosen to display these APGs under their most closely aligned strategic objectives.

Ending the HIV Epidemic. Ending the HIV Epidemic. End the HIV epidemic by reducing new HIV infections through 1) linking people to HIV medical care as quickly as possible so that treatment can be initiated; and 2) preventing HIV through prescribing pre-exposure prophylaxis (PrEP) to those who have indications for PrEP.  Starting from the baselines for December 31, 2017, by September 30, 2021:

  • Reduce by 15 percent new HIV infections among persons aged 13 or older.
  • Increase by 15 percent linkage to HIV medical care within one month of diagnosis among persons aged 13 or older.
  • Increase by 15 percent the number of persons with indications for PrEP who are prescribed PrEP.

Kidney Care. Reduce morbidity and mortality associated with end-stage renal disease and increase patient choice by improving access to alternatives to center-based dialysis.  Starting from the baseline for the calendar year ending December 31, 2019, by December 31, 2021:

  • Increase by 10 percent the number of new end-stage renal disease patients on home dialysis.
  • Increase by 10 percent the number of kidney transplants performed.

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