Numerous individual suggestions were made about how distribution systems could be improved in future emergency vaccination campaigns. These suggestions are compiled here as part of the factual summary of the workshops and should not be construed as reflecting consensus or endorsement by the workshops, the Preparedness Forum, or The National Academies. They are as follows:

• Develop better systems for tracking vaccine distribution to ensure improved situational awareness. Integrating existing systems and technologies, such as bar coding and electronic tracking, would improve the ability to track vaccine throughout the distribution system.

• Continue to use the Vaccines for Children program infrastructure as a foundation for emergency vaccination distribution programs.

• Consider developing an immunization program for adults analogous to the Vaccines for Children program.

• Include the ability to successfully ship in cold-weather environments as part of the criteria for awarding distribution contracts. Participants from some of the coldest states noted that on some days, vaccine could not be shipped because of concerns about freezing. They noted that systems that can ship in freezing temperatures exist and should be used.

• The federal government should deal directly with tribes (nation to nation).

• If federal authorities distribute ancillary supplies, they should ensure that the distribution process includes timely delivery of quality ancillary supplies that are appropriate for their intended use.