The study recommendations addressed federal and state funding levels, grant mechanisms for immunization programs, and the need for better measurement of immunization coverage. The committee recommended an increase in both federal and state budgets for support of immunization programs, but concluded that annual budgets for vaccine purchase for children have been adequate (this finding was made prior to the addition of the pneumococcal conjugate vaccine to the general schedule for children). The committee also recommended an increase in both federal and state budgets for the purchase of adult vaccines to provide additional vaccine for high-risk adolescents and adults under age 65 who do not qualify for other federal assistance.

In addition to budgetary increases, Dr. Smith noted that the IOM report proposed new operational and reporting requirements for federal grants to improve administrative efficiency, linking them to the six fundamental roles of the national immunization system. The committee recommended that CDC should distribute Section 317 awards to states through a formula grant mechanism, with the formula reflecting essential minimum funding levels and state need, capacity, and performance. In addition, a state match requirement should be added and the federal grants should have a two-year budget cycle to give states greater flexibility to plan and implement multi-year efforts.

Finally, the IOM report recommended that federal and state agencies should develop a set of consistent and comparable measures for use in monitoring the immunization status of children and adults enrolled in private and public health plans as well as populations in defined geo-graphic areas. For example, it would be valuable to harmonize the immunization measures of the Health Plan Employer Data and Information Set (HEDIS) and the National Immunization Survey (NIS).

Lance Rodewald and other representatives from the National Immunization Program of the Centers for Disease Control and Prevention described steps that have been taken to respond to the IOM recommendations (for further details, see www.cdc.gov/nip/news/iom-rpt-6-00.htm). CDC has revised the Section 317 grant guidance and program operations manual, giving states greater flexibility under the six broad immunization system roles outlined by the IOM study to tailor programs to local needs. In addition, discussions have begun to develop a funding formula and to improve the harmonization of HEDIS and the NIS.