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SET
ING
HOURSE
A STRATEGIC VISION FOR
IMMUNIZATION
PART ~
SUMMARY OF THE WASHINGTON
WORKSHOP
, D.C
Committee on the Immunization Finance Dissemination Workshops
Board on Health Care Services
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
ThE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
, ·,
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Gov-
erning Board of the National Research Council, whose members are drawn from
the councils of the National Academy of Sciences, the National Academy of Engi-
neering, and the Institute of Medicine. The members of the committee responsible
for the report were chosen for their special competences and with regard for
appropriate balance.
Support for this project was provided by the Centers for Disease Control and
Prevention. The views presented in this report are those of the Institute of Medi-
cine Committee on the Evaluation of Vaccine Purchase Financing in the United
States and are not necessarily those of the funding agencies.
International Standard Book Number 0-309-09068-7 (Book)
International Standard Book Number 0-309-52735-X (PDF)
Additional copies of this report are available from the National Academies Press,
500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or
(202) 334-3313 (in the Washington metropolitan area); Internet, http://
www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page at:
www.iom.edu.
Copyright 2003 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
The serpent has been a symbol of long life, healing, and knowledge among
almost all cultures and religions since the beginning of recorded history. The
serpent adopted as a logotype by the Institute of Medicine is a relief carving from
ancient Greece, now held by the Staatliche Museen in Berlin.
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"I(nowin,g is not enough; we must apply.
Willing is not enoa~,gh; we must do."
Goethe
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INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
Shaping the Future for Health
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THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating soci-
ety of distinguished scholars engaged in scientific and engineering research, dedi-
cated to the furtherance of science and technology and to their use for the general
welfare. Upon the authority of the charter granted to it by the Congress in 1863,
the Academy has a mandate that requires it to advise the federal government on
scientific and technical matters. Dr. Bruce M. Alberts is president of the National
Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter
of the National Academy of Sciences, as a parallel organization of outstanding
engineers. It is autonomous in its administration and in the selection of its mem-
bers, sharing with the National Academy of Sciences the responsibility for advis-
ing the federal government. The National Academy of Engineering also sponsors
engineering programs aimed at meeting national needs, encourages education
and research, and recognizes the superior achievements of engineers. Dr. Wm. A.
Wulf is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of
Sciences to secure the services of eminent members of appropriate professions in
the examination of policy matters pertaining to the health of the public. The
Institute acts under the responsibility given to the National Academy of Sciences
by its congressional charter to be an adviser to the federal government and, upon
its own initiative, to identify issues of medical care, research, and education. Dr.
Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sci-
ences in 1916 to associate the broad community of science and technology with
the Academy's purposes of furthering knowledge and advising the federal gov-
ernment. Functioning in accordance with general policies determined by the
Academy, the Council has become the principal operating agency of both the
National Academy of Sciences and the National Academy of Engineering in pro-
viding services to the government, the public, and the scientific and engineering
communities. The Council is administered jointly by both Academies and the
Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and
vice chair, respectively, of the National Research Council.
www. nationa l-academies.org
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COMMITTEE ON THE IMMUNIZATION FINANCE
DISSEMINATION WORKSHOPS
DAVID R. SMITH, M.D. (Chair), President, Texas Tech University
Health Sciences Center, Lubbock, TX
BRIAN BILKS, M.D., Professor and Chair, Department of Health
Services Management and Policy, The George Washington
University
STEVE BLACK, M.D., Co-Director, Vaccine Study Center, Kaiser
Permanente, Oakland, CA
GORDON H. DeFRIESE, Ph.D., President and Chief Executive Officer,
North Carolina Institute of Medicine, Woodcroft Professional
Center, Durham
DIANNE WHITE DELISI, M.A., State Representative, Texas House of
Representatives
R. GORDON DOUGLAS, OR., M.D., Former President, Merck Vaccines
(retired), Princeton, Nr
JONATHAN FIELDING, M.D., M.P.H., Director of Public Health and
Health Officer, Los Angeles County Department of Health Services
MAXINE HAYES, M.D., M.P.H., State Health Officer, Washington State
Department of Health, Olympia
ROBERT L. JOHNSON, M.D., Professor and Chair, Division of
Adolescent and Young Adult Medicine, University of Medicine and
Dentistry of New rersey-New Jersey Medical School
SAMUEL L. KATZ, M.D., Wilburt C. Davison Professor Emeritus,
Department of Pediatrics, Duke University Medical Center
WILLIAM KISSICK, M.D., M.P.H., Dr.P.H., George Seckel Pepper
Professor of Public Health, The Leonard Davis Institute, The
Wharton School, Philadelphia
RONALD I. SALDARINI, Ph.D., President, Wyeth Lederle Vaccines
and Pediatrics (retired), New Jersey
WILLIAM SCHAFFNER, M.D., Professor and Chairman, Department
of Preventive Medicine, Vanderbilt University School of Medicine
GARTH SPLINTER, M.D., M.B.A., Associate Professor, Chief Medical
Officer, University Hospital Trust, Oklahoma City, OK
Committee Staff
Rosemary Chalk, Senior Program Officer
Ryan Palugod, Senior Project Assistant
v
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REVIEWERS
This report has been reviewed in draft form by individuals chosen for
their diverse perspectives and technical expertise, in accordance with pro-
cedures approved by the National Research Council's Report Review
Committee. The purpose of this independent review is to provide candid
and critical comments that will assist the institution in making its pub-
lished report as sound as possible and to ensure that the report meets
institutional standards for objectivity, evidence, and responsiveness to
the study charge. The review comments and draft manuscript remain
confidential to protect the integrity of the deliberative process. We wish
to thank the following individuals for their review of this report:
Bernard Guyer, M.D., M.P.H., Chair, Department of Population and
Family Health Sciences, Johns Hopkins University Bloomberg School
of Public Health
Sara Rosenbaum, I.D., Director, Center for Health Policy Research,
School of Public Health and Health Services, The George Washington
University
Sandra Ross, Immunization Program Coordinator, Health and Hu-
man Services Agency, San Diego, California
lane E. Sisk, Ph.D., Professor, Department of Health Policy, Mount
Sinai School of Medicine
Although the reviewers listed above have provided many constructive
comments and suggestions, they were not asked to endorse the final draft
of the report before its release. The review of this report was overseen by
Neil Vanselow, M.D., Rio Verde, AZ. Appointed by the National Re-
search Council, he was responsible for making certain that an indepen-
dent examination of this report was carried out in accordance with insti-
tutional procedures and that all review comments were carefully
considered. Responsibility for the final content of this report rests entirely
with the authoring committee and the institution.
Al
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ACKNOWLEDGMENTS
The Institute of Medicine (IOM) workshop on immunization finance
was organized with the assistance of several health care organizations
and health care providers throughout the metropolitan area of Washing-
ton, DC, including the Association of State and Territorial Health
Officialss, the American Academy of Pediatrics, the American Associa-
tion of Health Plans, and the Washington Business Group on Health.
Staff from the National Immunization Program of the Centers for Disease
Control and Prevention (CDC) in Atlanta helped to identify immuniza-
tion program directors and public health advisers who served as speakers
and participants in the workshop. CDC officials also prepared data analy-
ses and exhibits to inform the workshop discussions.
The IOM workshop was audiocast on March 18, 2002. Electronic files
of the speakers' presentations are available at the IOM website: www.
iom.edu/iom/iomhome.nsf/Pages/Immunization+ Finance+dc+agenda.
. .
V11
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contents
EXECUTIVE SUMMARY
INTRODUCTION
A NATIONAL PERSPECTIVE ON THE IMMUNIZATION
SYSTEM
The National Immunization Partnership, 6
The Institute of Medicine Study, 9
Response from the Centers for Disease Control and Prevention, 11
BUILDING THE IMMUNIZATION INFRASTRUCTURE
State Perspectives, 15
Local Perspectives, 19
National Survey of State-Level Immun
Programs, and Practices, 20
Case Study Findings, 23
PRIVATE-SECTOR ROLES IN THE NATIONAL
IMMUNIZATION PARTNERSHIP
Immunization and Pediatric Practice, 25
Health Plan Incentives for Providers, 28
Business-Sector Roles, 31
1 ~
1
3
6
15
ization Policies,
25
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x
UNRESOLVED PROBLEMS AND FUTURE CHALLENGES
Increasing Vaccine Costs, 33
Changing Partnerships, 33
Immunization and Health Security, 34
Simplifying the Immunization System, 34
Stable Funding, 35
FINAL OBSERVATIONS
REFERENCES
APPENDIXES
A Workshop Agenda
B List of Workshop Participants
C Website Referrals
CONTENTS
33
36
38
41
44
47
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Tables, Figures, and BON
TABLES
1 Vaccines in Widespread Use, 1985-2020, 10-11
2 Vaccine Supply Policy, January 2000, 21
FIGURES
1 Changes in the childhood vaccine schedule, 1975-2000, 8
2 Six roles of the national immunization system, 12
3 Measles incidence per 100,000 population compared to available
federal grant funds ($ in millions), California, 1988-2000, 18
BOX
1 TOM Recommendations, Calling the Shots, 13
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