cent (CDC, 2001). For 2000, California also estimates that 61 percent of older adults had ever received a pneumococcal pneumonia vaccination, compared with the national estimate of 54 percent in 1999 (CDC, 2001). Rates in California are lowest for high-risk adults ages 18 to 64 and for African-Americans.

Efforts to sustain and improve immunization coverage include adding varicella to the immunizations required for day care and school entry. Dr. Smith reported that NIS data show that varicella coverage rates for 2-year-olds had reached 76 percent in 2000, up from just 26 percent in 1996– 1997. She expressed concern, however, that the current shortages of DTaP and varicella vaccines might contribute to lower coverage rates. Health plans, which must report their immunization coverage rates as a Health Plan Employer Data and Information Set measure, are also becoming concerned about the impact of vaccine shortages.

Immunization registries can aid in monitoring immunization coverage rates and in efforts to identify children in need of immunization services. Dr. Smith noted that in California registries had begun at the county level and that efforts are now under way to establish regional systems. California has submitted an application for funding from Medicaid to help support registry activities. A workshop participant urged state-level leadership in developing a comprehensive registry to overcome the problem of incomplete and scattered records, which can arise when families move from one community to another.

With California’s large population, the amount of state and federal immunization funding available per child is relatively modest compared with many other states. The state received $18.3 million in federal immunization grant funds for 2001, down from a peak of $36.5 million in 1996. A multiyear approach to federal Section 317 grants, as recommended by the Institute of Medicine (IOM), would aid the state in maintaining a more stable funding base for its immunization program. Dr. Smith noted that new federal funding for activities related to bioterrorism, some of which will be relevant for the immunization program, may be awarded on a multiyear basis.

California also supports efforts to implement the IOM recommendation for formula-based funding for Section 317 awards. A formula would help clarify the basis for federal funding decisions and is expected to produce a more equitable allocation of funds. In addition, Dr. Smith suggested targeting funds for “pockets of need” and giving greater attention to the implications of new vaccines and immunization recommendations for adolescents and adults. Overall, she urged maintaining an adequate level of funding to help break the “immunization cycle,” with disease outbreaks stimulating rapid but temporary funding increases (Roper, 2000).

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