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OCR for page 36
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
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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.
Representative terms from entire chapter:
immunization programs
