program representatives. IOM convened a workshop in Washington, D.C., in September 1999 to examine issues related to “pockets of need.” To supplement material available in the research literature, the committee also commissioned background papers on topics such as adult immunization, registries, measuring immunization coverage (Fairbrother et al., 2000b), and federal immunization policy (Johnson et al., 2000). Selected materials from the case study reports and commissioned papers were published in a supplemental issue of the American Journal of Preventive Medicine in October 2000.

In opening remarks at the Austin workshop, David R. Smith, president of Texas Tech University Health Sciences Center and chair of the IOM committee organizing the workshop, highlighted key findings and recommendations from the Calling the Shots report (IOM, 2000).² The study found that the nation’s immunization system faces serious challenges that could undermine past achievements and hinder the effort still needed to reach targeted levels of immunization coverage. Some of these demands include sustaining current rates of coverage with the addition of new and more expensive vaccines to the immunization schedule, responding to concerns about the safety of vaccines, serving an increased number of people as a result of recommendations for expanded vaccination of adolescents and adults, and adapting to changes in the health care delivery system that can affect the availability and affordability of vaccines in the private sector. The report recommends a renewal and strengthening of the federal-state partnership that is a fundamental element of the national immunization system. The report also recommends strategic investments in immunization efforts and closer collaboration between public and private health care systems to coordinate immunization roles and responsibilities in the wake of health care reforms.

The IOM study committee identified six fundamental roles for the nation’s immunization system (see also Figure 1):

• Control and prevent infectious disease;

• Assure the purchase of recommended vaccines for the total population of U.S. children and adults, with particular emphasis on the protection of vulnerable groups;