Agenda Item   



                                                                                                                        ASR Control  19-001321




legal entity taking action:

Board of Supervisors

board of supervisors district(s):

All Districts

SUBMITTING Agency/Department:

Health Care Agency   (Approved)

Department contact person(s):

Marc Meulman (714) 834-2980 



David Souleles (714) 0834-3882



Subject:  First Amendment Immunization Local Assistance Grant


      ceo CONCUR

County Counsel Review

Clerk of the Board


Approved Agreement to Form




3 Votes Board Majority




    Budgeted: Yes

Current Year Cost: N/A

Annual Cost: N/A




    Staffing Impact:


# of Positions:

Sole Source: N/A

    Current Fiscal Year Revenue: ($41,338)

  Funding Source: FED: 100% (Centers for Disease Control, Immunization Grant)

County Audit in last 3 years: No



    Prior Board Action: 12/12/2017#19






Approve the first Amendment to the Standard Agreement with the California Department of Public Health for the Immunization Local Assistance Grant for the period of July 1, 2019, through June 30, 2022, for a revised total maximum obligation of $3,320,793.



Authorize the Health Care Agency Director, or designee, to accept this Amendment and approve the Grant Agreement No. 17-10336, Amendment A01, with the California Department of Public Health.



Authorize the Health Care Agency Director, or designee, to execute such future amendments to the Agreement referenced above that do not change the Agreement amount by more than 10 percent of the original amount and/or make immaterial changes to the scope of work.







Approval of this Amendment with the California Department of Public Health for the Immunization Local Assistance Grant, will enable the County to promote immunization through community provider collaboration to improve vaccine access and reduce the incidence of vaccine preventable diseases.






Vaccinations have dramatically reduced death, disability and illness associated with many communicable diseases such as measles, polio, pertussis and influenza, and are a major contributor to the 25-year increase in life expectancy in the United States over the 20th century.


Since 1975, the Health Care Agency (HCA) has received funding through the California Department of Public Health (CDPH) for the Immunization Services to the General Public Project (formerly known as the Immunization Services to the General Public Project and as the Pediatric Immunization Project) to promote and provide vaccinations for children and adults in Orange County. Changes in public policy and the work of County staff with community, medical and school partners, have resulted in 95.7 percent of Orange County children entering kindergarten in the 2018-19 school year being up-to-date with required vaccinations, a 7.9 percent increase from the 10-year low of 88.7 percent in 2013.


On December 12, 2017, the Board of Supervisors (Board) approved a Grant Agreement with CDPH for the Immunization Services to the General Public Project for the period of July 1, 2017, through June 30, 2022, in the amount of $3,444,810.


HCA recently received an amendment for Grant Agreement No. 17-10336 from CDPH for the Immunization Local Assistance Grant, in the amount of $3,320,796 for the period of July 1, 2019, through June 30, 2022. Funding originates with the Centers for Disease Control and Prevention (CDC) Immunization Grant. A Funding decrease at the State level has resulted in a decrease in the County allocation, by $41,338 for each fiscal year of the remaining agreement term FY 2019-22. Total reduction for the remaining three year term totals $124,014. No reduction in services are associated with this funding decrease.


This project funds HCA staff to work with County and community providers to promote immunizations that reduce the incidence of preventable diseases, such as measles, pertussis, and influenza. Specific strategies under this agreement include:



Working with providers and organizations to increase adult/adolescent/child immunization rates.  This includes development and dissemination of consumer information through education, information, training and partnerships.


Convening the Orange County Immunization Council (OCIC) that provides a forum for education and networking of medical providers, school partners, community pharmacists and others to share updates on vaccine-preventable diseases and current immunization practices.


Coordinating, ordering, distributing and managing of federally-funded vaccine for use by local providers. This includes seasonal influenza vaccine and vaccine used in management of outbreaks.


Supporting health care provider quality assurance activities through site visits, education and technical assistance.


Conducting outreach and coordination with medical and community partners to conduct seasonal influenza vaccination efforts to at-risk, under-served populations.


Visiting CDPH selected child care centers and elementary schools to review compliance with the recommended childhood immunization schedule.  On behalf of CDPH staff, provide technical assistance for assurance of proper documentations and alignment of institutions with CDPH requirements for enrollment. Findings are reported back to CDPH.


Providing Public Health Nursing case management services to newborns at risk of Hepatitis B to assure the timely receipt and completion of the Hepatitis B vaccine series.


Program outcomes include the following:



FY 2016-2017

FY 2017-2018

FY 2018-2019

Number of OCIC members receiving education




Community seasonal influenza vaccine doses*




Child Care and Kindergarten Vaccination Records Review**

Number of Kindergartens: 26

Number of Children:  1,967

# of Child Care Centers: 35

# of Children:  2,837

# of Kindergartens: 35

# of Children: 2,780

Case management of at-risk newborns for Hepatitis B




* Collective messaging and expanded health insurance coverage have provided the opportunity for more individuals to obtain the vaccine from their primary medical provider or local pharmacy, resulting in a decline in the numbers of CDPH-supplied vaccine doses utilized by County and community providers.


**The numbers of schools and childcare centers reviewed are determined by CDPH and vary annually.


The initial Agreement contained two different indemnification provisions that differ from the County's standard of sole indemnification. The first provision relates to general claims, and the second provision relates to intellectual property infringement claims. CEO/Risk Management has reviewed and approved these provisions.


HCA requests that the Board approve the Grant Amendment with CDPH for the Immunization Local Assistance Grant as referenced in the Recommended Actions.






The revenue reduction associated with this Grant Agreement Amendment will be absorbed within Budget Control 042 FY 2019-20 Budget and will be included in the budgeting process for future years.











Attachment A - First Amendment to the Standard Agreement Number 17-10336 A01
Attachment B - Risk Assessment Form