IOM recommended that CDC provide Congress with estimates of the cost of vaccines added to the childhood immunization schedule so that those estimates can be factored into the Section 317 budget. Dr. Orenstein commented that although Congress has not requested such estimates, CDC is seeking better information about factors affecting vaccine pricing and the demand for publicly purchased vaccine. A new IOM study will examine vaccine financing strategies that reflect the roles and responsibilities of the public and private sectors in the purchase of vaccine and associated administrative costs. The study will also consider the effect of vaccine pricing on incentives for further vaccine research and production and will assess prospects for future vaccine prices.

Little progress has been made at the federal level in increasing funding for the purchase of vaccine for adolescents and adults. CDC is, however, trying to address this issue in other ways such as urging public and private health plans to include or improve coverage for adolescent and adult immunizations. CDC is also encouraging states to enroll health care providers who treat adolescents in VFC so that they can obtain free VFC vaccine for eligible patients. The enrollment of more adolescents in State Child Health Insurance Programs is also seen as an opportunity to improve access to lower cost immunization services for this population. In addition, standards for adult immunization practices, comparable to the standards developed in the 1990s for young children, were recently issued, and work is beginning on standards for immunization of adolescents. The Task Force for Community Preventive Services will be developing evidence-based guidelines for immunization interventions aimed at certain target populations.

Dr. Orenstein reported welcome increases in funding for Section 317 immunization infrastructure grants in 2001 and 2002. Even so, the funding level remains about $18 million to $19 million short of the $200 million that IOM recommended. CDC is exploring whether to extend the grant period to 2 years, but Congress reauthorized the Section 317 program before such a proposal could be submitted. CDC is working with grantees to reduce the reporting burden associated with these grants and to improve the documentation of state financial and in-kind contributions to immunization activities.

The formula grant mechanism that IOM recommended for the distribution of Section 317 infrastructure funds offers the advantages of greater equity and transparency in funding decisions, but it poses a challenge in that some states will end up receiving less funding. The recent budget increases will help ease the impact of the reallocation of funding, and CDC has agreed that a state’s funding will decrease by no more than 5 percent per year. CDC is working with the states, through the Association of State and Territorial Health Officials and the Association of Immu-



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