with the pneumococcal conjugate vaccine). Insurance plans also can be slow to add coverage for new vaccines. Dr. Siegel commented that fear or skepticism may slow acceptance of a new vaccine. In Dallas, for example, providers found that they had to counter inaccurate information in the media about the new pediatric pneumococcal vaccine. In addition, recent shortages of both older and new vaccines have been a reminder of the critical role of vaccine manufacturers in the success of immunization programs.

VFC offers opportunities to strengthen a public-private partnership in support of immunization efforts in Texas. Dr. Siegel encouraged efforts to increase provider participation in the program. At present, about 60 percent of the private providers in the El Paso area participate in VFC, but only about 20 to 30 percent of the private providers in Dallas, Houston, and San Antonio (Bexar County) participate in the program (Figure 5). With a strong base of immunization providers in the private sector participating in VFC, the health department could devote additional resources to provider education on topics such as vaccine handling and storage, immunization assessments and reminder/recall systems, and vaccine safety concerns. The barriers to participation in VFC identified by Dr. Siegel include a lack of knowledge about the program, concerns about the administrative burden, a lack of access to certain combination vaccine products, lower reimbursement rates, and concerns over raising patient expectations for other free services.

FIGURE 5 Provider^a participation in Texas VFC, by county, October 2000–September 2001.

^aProviders are licensed MDs that are designated family practice, general practice, pediatrics, or internal medicine.