Introduction
Instabilities in the U.S. immunization system and uncertainties in the public health infrastructure that supports it are contributing to persistent gaps in the delivery of immunization services, one of the most valuable public health tools for preventing serious illness and death. In June 2000, an Institute of Medicine (IOM) report, Calling the Shots: Immunization Finance Policies and Practices (IOM, 2000), pointed to several disturbing signs for the immunization system: growing uncertainties regarding vaccine purchase and service delivery arrangements, increasing financial burdens and operational complexities in administering vaccines, shortcomings in public- and private-sector investments in vaccine purchases and immunization programs, and fluctuations in public and private health care plans that support immunization services.
The national immunization system is a partnership that relies on multiple and diverse relationships. Such relationships involve federal agencies and programs, health officials in state and local governments, health care providers, employers, insurers and health plans, vaccine manufacturers, and others in the private sector. The Centers for Disease Control and Prevention (CDC) requested that IOM undertake a special effort to reach these various groups as part of the dissemination activities for Calling the Shots. Three regional workshops and a national meeting are being held to review the findings and recommendations of the IOM report and to examine their implications for health care policy within local and state governments, the coverage of immunization benefits within
private health plans, and the delivery and quality of heath care services, especially within disadvantaged communities.
The IOM workshop discussions are designed to achieve the following goals:
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Foster awareness of the conclusions and recommendations of Calling the Shots;
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Strengthen interactions among officials in the public and private health care sectors to build consensus about immunization infrastructure initiatives, measurement approaches, and financing plans; and
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Identify unresolved public health and health care finance issues and concerns at the regional, state, and local levels that require further attention from public and private policy makers.
The first of the three workshops, held in Chicago, Illinois, in June 2001, focused on statewide concerns in Illinois and Michigan and the challenges facing the cities of Chicago and Detroit, where metropolitan-area immunization rates are consistently lower than state-level rates (IOM, 2002).
This report summarizes the discussions of the second dissemination workshop, which focused on Texas. The meeting was held in October 2001 in Austin, Texas, at the offices of the Texas Medical Association and with additional collaboration by the Texas Department of Health and Texas Tech University Health Sciences Center. Participants included state and local officials; health care providers from across the state; representatives of health plans, corporate health care purchasers, and vaccine manufacturers; state legislators and community leaders; staff from CDC; consultants and other contributors to Calling the Shots; and members and staff of the IOM workshop planning committee.
The workshop provided an opportunity for this diverse audience to hear varied, and sometimes unfamiliar, views on immunization finance issues and to gain new insights into ways immunization concerns might be addressed in Texas and elsewhere. The discussions, summarized in this report, also reflected new concerns and priorities resulting from the terrorist attacks of September 11, 2001, and the evidence, which had only started to emerge at the time of the workshop, of the health threats from the deliberate distribution of anthrax spores. Individual speakers proposed a wide array of approaches, including educational strategies, professional programs, and legislative and regulatory reforms, to address immunization concerns (see Appendixes A to C for the workshop agenda, a list of workshop participants, and addresses of Internet websites that pertain to the IOM report and the workshop discussions, respectively).
