Executive Summary
Immunization is essential to disease prevention efforts in public health, but the U.S. health care system faces financial challenges that are affecting the delivery of immunization services. An earlier report from the Institute of Medicine (IOM), Calling the Shots: Immunization Finance Policies and Practices (IOM, 2000), pointed to the instability of the fundamental infrastructure that supports immunization programs throughout the United States, including growing financial burdens and operational complexities in immunization services, shortcomings in public- and private-sector investments in vaccine purchases and immunization programs, and fluctuations in insurance plans in the public and private health care sectors that create uncertainties regarding coverage of vaccine purchase and service delivery arrangements.
Calling the Shots recommended renewing and strengthening the federal-state partnership at the heart of the national immunization system, expanding strategic investments in immunization efforts, and fostering closer collaboration between public and private health care systems. As a framework to guide these efforts, IOM identified six fundamental roles for the nation’s immunization system: (1) control and prevent infectious disease; (2) assure the purchase of recommended vaccines for the total population of U.S. children and adults, with a particular emphasis on the protection of vulnerable groups; (3) assure access to such vaccines within the public sector when private health care services are not adequate to meet local needs; (4) conduct populationwide surveillance of immunization coverage levels, including the identification of significant disparities,
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-
cies and professional groups can also establish incentives to encourage more providers, including all physicians who provide health care to adolescents and adults, to participate in immunization programs such as the Vaccines for Children program (VFC). Local health care providers indicated that immunization finance and service delivery in Texas is at present a complicated patchwork of public- and private-sector activities. Workshop participants expressed interest in reducing the gaps and complexities within the current health care system while also building on the strengths of diversity and flexibility.
Many workshop participants also urged greater coordination among various agencies and organizations that periodically review health plan and provider records and better education of employers and health plan administrators regarding the distinction between required and recommended immunizations. Speakers and discussants explored the feasibility of developing annual reminder notices for high-risk children from vaccine registries as well as creating a universal vaccine purchase program that might draw on public funding from federal and state sources as well as private funding from health plans, insurers, employers, and other purchasers of health care services. The discussions among the IOM workshop participants also reflected the concerns about health security raised by the September 11, 2001, terrorist attacks, which occurred in the weeks just before the Austin workshop. Participants expressed a renewed appreciation of the importance of the public health infrastructure and highlighted the immunization system as a fundamental indicator of its strength. Although crisis can stimulate urgent action, participants observed that the achievement of immunization objectives requires sustained efforts, strategic goals, and long-term finance plans to maintain the public health infrastructure.
