health care nor an effective or appropriate use of limited resources. Several speakers observed that all immunization providers should be able to monitor registry records and should be encouraged to do so to avoid unnecessary immunizations. Efforts to educate parents about immunization should address the appropriate timing of immunizations as well as the number. In addition, the emphasis on meeting immunization goals should not contribute to the fragmentation or neglect of provision of other primary care for young children. Dr. Burns suggested that responsibility for staff and professional training and patient education might be a shared undertaking of providers, health departments, communities, and other organizations, such as the Texas Medical Association.

Dr. Burns proposed consideration of universal vaccine purchase as a way to create a more seamless immunization system in Texas. Such a system may have the potential to alleviate problems such as confusion over insurance coverage and vaccine-related financial burdens for private providers. It might be possible to develop a public-private collaboration to fund universal purchase by involving insurers and health plans, which already have obligations to provide vaccines or cover vaccine costs. Dr. Freed noted that the recent adoption of universal purchase in North Carolina was associated with increased immunization coverage rates, but these efforts are expensive. The increased cost of vaccines may threaten the continuation of such programs in some states.