Furthermore, federal and state governments share responsibility for supporting vaccine purchase and the infrastructure essential for achieving and sustaining national immunization goals. Data reviewed for the study showed that some states appeared to provide little or no state funding for immunization, whereas others invested substantially more than they received from federal sources. Finally, the IOM committee observed that the private sector, through health plans and individual health care providers, has the capacity to do more to ensure the delivery of appropriate immunization services to health plan members and providers’ patients. Yet such efforts do not replace the need for a public health infrastructure capable of ensuring that the immunization needs of the whole population are addressed.

The IOM study recommendations addressed federal and state funding levels, grant mechanisms for immunization programs, and the need for better measurement of immunization coverage levels. The committee concluded that annual budgets for the purchase of vaccines for children have been adequate. However, this finding was made before the addition of the pneumococcal conjugate vaccine to the recommended schedule for children, and this vaccine is more expensive than all other vaccines routinely administered to children combined. The committee recommended that increases in both federal and state budgets be made to provide for the purchase of additional vaccines for those high-risk adolescents and adults under age 65 who do not qualify for other federal assistance. The committee also recommended increases in financial and administrative support from federal and state governments for immunization program infrastructure.

In addition to budgetary increases, Dr. Smith noted that the IOM report proposed new operational and reporting requirements for the federal grants linked to the six fundamental roles for the national immunization system. The committee recommended that CDC distribute Section 317 program awards to states through a formula grant mechanism, with the formula reflecting base funding levels and additional amounts that reflect state need, capacity, and performance. In addition, a state matching requirement should be added, and the federal grants should have a 2-year budget cycle to give states greater flexibility to plan and implement multiyear efforts. Finally, the IOM report recommended that federal and state agencies 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 those of populations in defined geographic areas.

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