topics of adult immunization, registries, measuring immunization coverage (Fairbrother et al., 2000b), and federal immunization policy (Johnson et al., 2000) to supplement material available in the research literature. Selected materials from the case study reports and commissioned papers were published in a supplemental issue of The American Journal of Preventive Medicine in October 2000.


The IOM report Calling the Shots recommends a renewal and strengthening of the federal-state partnership that is a fundamental element of the national immunization system. The report also recommends strategic investments in immunization efforts and closer collaboration between public and private health care systems to coordinate immunization roles and responsibilities in the wake of health care reforms.

In opening remarks at the Chicago workshop, David Smith highlighted the key findings and recommendations from the IOM study.2 The study committee identified six fundamental roles for the nation’s immunization system:

  1. Assure the purchase of recommended vaccines for the total population of U.S. children and adults, with particular emphasis on the protection of vulnerable groups.

  2. Assure access to vaccines within the public sector when private health care services are not adequate to meet local needs.

  3. Control and prevent infectious disease.

  4. Conduct populationwide surveillance of immunization coverage levels, including the identification of significant disparities, gaps, and vaccine safety concerns.

  5. Sustain and improve immunization coverage levels within child and adult populations, especially in vulnerable communities.

  6. Use primary care and public health resources efficiently in achieving national immunization goals.

The IOM study committee used this framework to guide its finance recommendations. The report concluded that adequate, stable, and pre-dictable funding was necessary for the development of effective state immunization programs and that the fluctuations in Section 317 infrastructure funding during the 1990s made it difficult for states to achieve


Several speakers in the workshop used visual aids in their presentations. These materials are available in electronic form at the workshop website:

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