conjugate vaccine. The increased cost of recommended vaccines has significant budgetary implications, and Dr. Rodewald noted the need for better tools to estimate annual vaccine requirements. In addition, vaccine shortages (e.g., the influenza vaccine and the diphtheria and tetanus toxoids and activated pertussis vaccine [DTaP]) pose problems of ensuring equitable allocation and appropriate targeting of available vaccine supplies.

For the immunization infrastructure component of the Section 317 program, CDC is encouraging grantees to pursue evidence-based strategies for improving immunization rates. Recommendations from the Task Force on Community Preventive Services (2000) include, among others, reducing out-of-pocket costs to families, implementing reminder/recall systems to notify families that a child is due or past due for vaccination, and giving providers feedback from assessments of rates of immunization coverage among their patients.

OVERVIEW OF STATE CONCERNS

Gary Freed, of the University of Michigan, reviewed the findings from a series of interviews with immunization program officials in all 50 states. Conducted as part of the data collection effort for Calling the Shots (IOM, 2000), these interviews helped document features of state immunization programs and state responses to changes in federal immunization policies and funding for vaccines and immunization programs. For vaccine purchase, Dr. Freed and colleagues found that states relied heavily on federal funding, with 11 states allocating no additional state funds for this purpose. In 21 states, including Texas, between 2 and 10 percent of the funding for publicly purchased vaccines came from state funds. The remaining states provided larger amounts of funding. State officials cited several factors that had placed new demands on budgets for vaccine purchase during the 1990s, including the addition of new and more expensive vaccines to the recommended schedule of immunizations, delays in VFC coverage of and federal contracts for new vaccines, and demand for vaccines not included in VFC.

In Texas, for example, the hepatitis A vaccine is recommended for some children but it is not a vaccine included in VFC. State officials also reported pressure from health care providers to supply publicly purchased vaccine for children who are not eligible for VFC. In addition, they felt that the Advisory Committee on Immunization Practices (ACIP) failed to give adequate consideration to the financial impact of its recommendations to add vaccines to the immunization schedule and, therefore, to the set of vaccines for which children were eligible under public programs.



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