improve the delivery of medical services in medically underserved areas of the United States. In 1972, the NHSC Scholarship Program was initiated. This program underwrites the costs of medical education and in return requires physicians trained with NHSC money to repay their debt by serving in areas in which health services are inadequate (Brown and Stone, 1990). The committee is unaware of any similar program directed toward those who wish to train for careers in public health and related disciplines, such as epidemiology, infectious disease, and medical entomology. Because more individuals with training in these disciplines are likely to be needed to fulfill the United States' commitments to the implementation of a global infectious disease surveillance network, the establishment of such a program, modeled after the NHSC, might help to attract individuals who otherwise would not consider public health careers.
The committee recommends that Congress consider legislation to fund a program, modeled on the National Health Service Corps, for training in public health and related disciplines, such as epidemiology, infectious diseases, and medical entomology.
Vaccines and antimicrobial drugs have led to dramatic improvements in public health in the United States and in much of the rest of the world during the latter half of this century. Despite this encouraging history, the committee is concerned that many of the vaccines and drugs available today have been used for decades. It believes that there is a need to review the present vaccine and drug armamentaria with a view toward improving availability and surge capacity (potential for emergency response), as well as safety and efficacy.
Vaccines are one of the most cost-effective means now available for preventing disease. The Haemophilus influenza type B (Hib) vaccine is a good example. With its newly approved use (the vaccine is given at 2 months of age instead of at 18 months) and assuming an effectiveness rate of 72 percent, the total cost savings for vaccinating a one-year cohort of infants is estimated to be more than $359 million. (Including the cost of providing and administering the vaccine, this works out to $106 million in vaccine costs versus $465.3 million in disease/morbidity/mortality costs [M. Rowe, Policy Analysis and Legislation Branch, NIAID, personal communication, 1992].)
In addition to protecting the individual who has been vaccinated, the