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Suggested Citation:"Final Observations." Institute of Medicine. 2003. Setting the Course: A Strategic Vision for Immunization: Part 4: Summary of the Washington, D.C., Workshop. Washington, DC: The National Academies Press. doi: 10.17226/10856.
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Page 36
Suggested Citation:"Final Observations." Institute of Medicine. 2003. Setting the Course: A Strategic Vision for Immunization: Part 4: Summary of the Washington, D.C., Workshop. Washington, DC: The National Academies Press. doi: 10.17226/10856.
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Page 37

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Final Observations Institute of Medicine (IOM) report Calling the Shots and the four regional workshops that followed its publication provide a snapshot of current tensions and uncertainties within the national immuniza- tion system. Although states retain the primary responsibility for deter- mining the public health priorities of their communities and developing policies and programs to address those needs, the federal government exercises a profound influence on the quality and scope of state immuni- zation programs. By providing funds, vaccine, personnel, and technical assistance, the National Immunization Program at the Centers for Disease Control and Prevention is a key force in shaping the areas that receive attention within the states and highlighting certain strategies that can achieve national as well as state-level goals. As noted in the IOM report, the repetitive ebb and flow cycles in the distribution of public resources for immunization programs have created instability and uncertainty that impeded project planning at the state and local levels in the late 1990s, and delayed the public benefit of advances in the development of new vaccines for both children and adults (Conclu- sion 1~. Although federal and state governments have important roles to play in reducing this instability, private health care plans and providers are additional partners that have the capacity to do more in implementing immunization surveillance and preventive programs within their health practices. The business sector, which is responsible for purchasing health care benefits for employees and their dependents, is another component 36

FINAL OBSERVATIONS 37 in the evolving national immunization system whose role has not yet fully developed. Under some circumstances, patchwork efforts and informal collabo- ration can achieve significant results. The growing diversity of health care plans in both the private and public sectors has led to an increasing frag- mentation in the service delivery system and financing strategies for im- munization. Participants in the workshop stressed the importance of ad- dressing this fragmentation through new partnerships that can generate consistent program priorities and performance measures. Such efforts will require additional resources to support routine infrastructure efforts as well as special initiatives. No single agency or program has the capac- ity to do it all, but synergistic efforts have the potential to achieve pro- grams that have greater stability and higher levels of immunization cov- erage, especially in underserved areas.

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In 2000, the Institute of Medicine (IOM) produced a report Calling the Shots: Immunization Finance Policies and Practices (IOM, 2000a) that illustrated the uncertainties and instability of the public health infrastructure that supports U.S. immunization programs. The IOM report proposed several strategies to address these concerns and to strengthen the immunization infrastructure. In March 2002, a group of 50 health officials, public health experts, health care providers, health plan representatives, health care purchasers, and community leaders met at The National Academies in Washington, DC to explore the implications of the IOM findings and recommendations for the federal and state governments. Private health plans and business sector representatives also participated in the meeting to discuss their role in fostering high levels of immunization coverage. The one-day workshop was the fourth and last in a series of meetings organized by IOM with support from the CDC to foster informed discussions about future financing strategies for immunization and the public health infrastructure. This report of the Washington, DC workshop summarizes the findings of the IOM study, reviews the implementation of the IOM recommendations, and highlights continuing immunization finance challenges for the nation as a whole as well as state and local health departments.

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