gaps, and vaccine safety concerns; (5) sustain and improve immunization coverage levels within child and adult populations, especially in vulnerable communities; and (6) use primary care and public health resources efficiently in achieving national immunization goals. In October 2001, a group of about 50 health officials, public health experts, health care providers, health plan representatives and purchasers, state legislative officials, and community leaders met at the Texas Medical Association in Austin to explore the implications of the IOM findings and recommendations for Texas. The 1-day workshop was the second in a series of four meetings organized by IOM with support from the Centers for Disease Control and Prevention to foster informed discussions about challenges for immunization finance and future strategies for strengthening immunization activities and the public health infrastructure that supports those activities.

This report of the Austin workshop summarizes the findings of the previous IOM report and reviews continuing challenges in immunization finance for the nation and for individual states, with a particular focus on Texas. The report also highlights strategies proposed by individual workshop participants that can be used to address those challenges. Several presenters and discussants emphasized that adequate funding is necessary for immunization programs but that financial resources alone are not sufficient to guarantee success. Similarly, they indicated that no single agency or group in the public or the private sector should expect, or should be expected, to solve immunization problems. Speakers from both public and private health agencies observed that collaboration, consultation, and partnership efforts across levels of government and between the public and private sectors are essential.

During the workshop, several speakers highlighted future strategies that deserve consideration. For example, immunization supporters in the public health community must communicate more effectively with key partners in the private health care sector. Immunization recommendations and public health goals must be clearly understood by health plan officials and employers, who make important decisions regarding coverage of health benefits. Health care providers also have valuable insights into the critical barriers and limitations in both public and private financing for purchase of vaccines and payment for immunization services. Problems of vaccine shortages and vaccine distribution must be addressed in collaboration with vaccine manufacturers.

For Texas, in particular, the workshop discussions suggested several next steps. Legislative action is one strategy, for example, creating new criteria and guidelines for the development of the state’s immunization registry through an opt-out strategy rather than the current opt-in approach to improve the completeness of registry records. State health agen-



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