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Setting the Course: A Strategic Vision for Immunization, Part 2 Summary of the Austin Workshop SETTING THE COURSE A STRATEGIC VISION FOR IMMUNIZATION PART 2 SUMMARY OF THE AUSTIN WORKSHOP Committee on the Immunization Finance Dissemination Workshops Division of Health Care Services INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu
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Setting the Course: A Strategic Vision for Immunization, Part 2 Summary of the Austin Workshop THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. Support for this project was provided by the Centers for Disease Control and Prevention. The views presented in this report are those of the Institute of Medicine Committee on Immunization Finance Dissemination Workshops and are not necessarily those of the funding agencies. International Standard Book Number 0-309-08517-9 Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, N.W., Box 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2002 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
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Setting the Course: A Strategic Vision for Immunization, Part 2 Summary of the Austin Workshop “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE Shaping the Future for Health
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Setting the Course: A Strategic Vision for Immunization, Part 2 Summary of the Austin Workshop THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org
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Setting the Course: A Strategic Vision for Immunization, Part 2 Summary of the Austin Workshop COMMITTEE ON THE IMMUNIZATION FINANCE DISSEMINATION WORKSHOPS DAVID R. SMITH, M.D. (Chair), President, Texas Tech University Health Sciences Center, Lubbock, TX BRIAN BILES, M.D., Professor and Chair, Department of Health Services Management and Policy, The George Washington University STEVE BLACK, M.D., Co-Director, Vaccine Study Center, Kaiser Permanente, Oakland, CA GORDON H. DeFRIESE, Ph.D., President and Chief Executive Officer, North Carolina Institute of Medicine, Durham DIANNE WHITE DELISI, M.A., State Representative, Texas House of Representatives R. GORDON DOUGLAS, JR., M.D., Former President, Merck Vaccines (retired), Princeton, NJ JONATHAN FIELDING, M.D., M.P.H., Director of Public Health and Health Officer, Los Angeles County Department of Health Services MAXINE HAYES, M.D., M.P.H., State Health Officer, Washington State Department of Health, Olympia ROBERT L. JOHNSON, M.D., Professor and Chair, Division of Adolescent and Young Adult Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School SAMUEL L. KATZ, M.D., Wilburt C. Davison Professor Emeritus, Department of Pediatrics, Duke University Medical Center WILLIAM KISSICK, M.D., M.P.H., Dr.P.H., George Seckel Pepper Professor of Public Health, The Leonard Davis Institute, The Wharton School, Philadelphia RONALD J. SALDARINI, Ph.D., President, Wyeth Lederle Vaccines and Pediatrics (retired), New Jersey WILLIAM SCHAFFNER, M.D., Professor and Chairman, Department of Preventive Medicine, Vanderbilt University School of Medicine GARTH SPLINTER, M.D., M.B.A., Associate Professor, Chief Medical Officer, University Hospital Trust, Oklahoma City, OK Committee Staff ROSEMARY CHALK, Senior Program Officer JANE DURCH, Consultant RYAN PALUGOD, Project Assistant
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Setting the Course: A Strategic Vision for Immunization, Part 2 Summary of the Austin Workshop REVIEWERS This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Gerry Fairbrother, Ph.D., The New York Academy of Medicine Bernard Guyer, M.D., M.P.H., The Johns Hopkins University Sara Rosenbaum, J.D., The George Washington University Sharilyn Stanley, M.D., Texas Department of Health Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Neal A. Vanselow, M.D., Rio Verde, Arizona. Appointed by the National Research Council and Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
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Setting the Course: A Strategic Vision for Immunization, Part 2 Summary of the Austin Workshop ACKNOWLEDGMENTS The Institute of Medicine workshop on immunization finance was organized with the generous assistance of many individuals and organizations in Austin and throughout the state of Texas. We acknowledge in particular the gracious hospitality provided by the staff and officers of the Texas Medical Association, particularly Gayle Harris, Brent Annear, Ken Ortolon, Steven Levine, and their colleagues. David Smith and Richard Butler from the Texas Tech University Health Sciences Center and Eduardo Sanchez, Charles Bell, Sharilyn Stanley, Lynn Denton, Linda Linville, Lucina Suarez, Brad Prescott, and their associates in the Texas Department of Health also provided invaluable assistance in identifying key experts, resource materials, and technical support for the meeting. Jane Durch, consultant to the Institute of Medicine, provided an excellent summary of the workshop that served as the basis for the final report. Additional guidance was provided by the Texas Pediatric Society, the Texas Association of Local Health Officials, the Texas Association of Health Plans, and the Dallas-Fort Worth Business Group on Health in identifying appropriate speakers and participants. The legislative office of Texas Representative Dianne White Delisi assisted with promoting the workshop among members and staff from the Texas legislature. Jane Siegel, Janet Squires, and Mary Droge from the Texas Pediatric Society prepared editorial materials to help publicize the meeting and immunization issues within the state. County health department officials, especially representatives from the Austin/Travis County Health and Human Services Department and the El Paso City-County Health and Environment District, were also most helpful. Staff from the National Immunization Program of the Centers of Disease Control and Prevention in Atlanta helped to identify immunization program directors and public health advisers in Texas and also prepared data analyses to inform the workshop discussions. The Center for the Advancement of Distance Education (CADE) at the University of Illinois provided on-site technical support for an audiocast of the October 12th workshop to a national audience. An archival copy of the speakers’ remarks and slides can be found at the IOM website: www.iom.edu/iom/iomhome.nsf/pages/hcs+immunization+finance+dissemination.
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Setting the Course: A Strategic Vision for Immunization, Part 2 Summary of the Austin Workshop Contents EXECUTIVE SUMMARY 1 INTRODUCTION 4 BACKGROUND 6 Examining Immunization Finance Policies and Practices, 7 IOM Findings and Recommendations, 8 CDC Responses to IOM Recommendations, 11 NATIONAL PERSPECTIVES ON THE IMMUNIZATION SYSTEM 12 Overview of State Concerns, 14 IMMUNIZATION ISSUES IN TEXAS 16 Texas Department of Health, 17 A Legislator’s View, 21 A Local Perspective, 22 PROVIDER PERSPECTIVES 24 Potential for Greater Immunization Benefits for Adults, 26 Practical Challenges for Private Providers, 27 HEALTH PLANS AND EMPLOYERS 31 Health Plan Perspectives, 31 How Employers View Immunization Coverage, 33
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Setting the Course: A Strategic Vision for Immunization, Part 2 Summary of the Austin Workshop CDC STRATEGIES FOR IMMUNIZATION FINANCE 35 CONCLUDING OBSERVATIONS 38 REFERENCES 40 APPENDIXES A Workshop Agenda 45 B Workshop Participants 48 C Website Referrals 54
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Setting the Course: A Strategic Vision for Immunization, Part 2 Summary of the Austin Workshop Tables and Figures TABLES 1 Change in annual morbidity from vaccine-preventable diseases: prevaccine baseline and 2000, 13 2 Estimated vaccination coverage for the 4:3:1:3 series among children ages 19 to 35 months, 1996–2000, 17 FIGURES 1 Six roles of the national immunization system, 9 2 Amount and source of funds for the Texas Immunization Program, 2001, 18 3 Amount and source of funding for vaccines, Texas Department of Health, 1993–2001, 19 4 Amount and source of funding for immunization infrastructure, Texas Department of Health, 1993–2001, 20 5 Provider participation in Texas VFC, by county, October 2000– September 2001, 25
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