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Public health director urges county budgeting for vaccine gaps as federal guidance shifts
Summary
Public Health Director Dr. Tim Ryan briefed the Board on vaccine availability, rising measles activity and changes to federal advisory guidance. He requested a budget proposal to fill coverage gaps caused by changing federal recommendations and insurers that may refuse payment.
Public Health Director Dr. Tim Ryan told the Board on Aug. 19 that shifting federal vaccine recommendations and payer practices are creating coverage gaps the county may need to fill if residents are to retain affordable access to vaccines.
Dr. Ryan, who said his team vaccinated more than 11,000 people during the COVID pandemic, described three near‑term problems: (1) a national reconstitution of the Advisory Committee on Immunization Practices (ACIP) and changes to its recommendations that have led professional groups such as the American Academy of Pediatrics to publish their own guidance; (2) some insurers, notably Kaiser, declining to reimburse the county for vaccines administered outside the insurer’s network; and (3) supply and ordering uncertainty that makes planning difficult.
“We get different pots of money to pay for certain groups of people,” Dr. Ryan said. “If a vaccine is not recommended [by ACIP], an insurance company will not pay for it. And if an insurance company will not pay for a vaccine, people won't get it.”
Dr. Ryan said the county’s immunization program routinely vaccinates infants through older adults and partners with clinics, schools and local organizations, but that he is seeing an increase in inquiries from people whose insurers will not cover recommended immunizations. He said some vaccines cost “from $30 to $700” each depending on the product and that the department lacks an internal fund to cover privately insured residents who cannot afford out‑of‑pocket payments.
He asked the Board to direct staff to prepare a budget proposal for 2026 that would identify options for county funding to backfill vaccine access gaps — a request the Board supported in principle and asked be returned with a cost estimate for consideration in the upcoming budget process. Assistant County Manager for Finance Rachel Harlischalk said the county has begun 2026 budget planning and would place the request on the budget track for Board review.
Dr. Ryan also raised staff safety concerns at the public‑health clinic and asked the Board to support procurement of panic‑button devices and other workplace safety measures; commissioners agreed to pursue solutions and asked staff to identify obstacles so the Board can help remove them.
On disease surveillance, Dr. Ryan warned that measles activity has increased nationally and that contact tracing after a single case required seven counties to notify approximately 700 people — an outcome he cited as evidence of public‑health readiness and the protective value of vaccination.
Commissioners asked for a budget estimate and for an update on staff safety and operational planning at a future quarterly public‑health briefing.
