largely through the Departments of the Army and Navy; and the U.S. Food and Drug Administration (FDA). DOD and CDC purchase vaccines at federally negotiated contract prices and distribute them to the military and civilian sectors, respectively. Regulatory oversight and licensure are performed by FDA's Center for Biologics Evaluation and Research (CBER). Demonstration projects, field testing, and postmarketing surveillance for vaccines are conducted or funded by AID, CDC, and FDA. The National Vaccine Program (NVP), which is part of the Office of the Assistant Secretary for Health of the U.S. Department of Health and Human Services, is authorized to coordinate and provide direction to the nation's various vaccine-related efforts; this mandate is carried out under the guidance of the National Vaccine Advisory Committee, which is composed of representatives of government agencies, public health experts, private industry, and citizens groups.

U.S. Federal Agencies and Programs

U.S. Agency for International Development

The U.S. Agency for International Development participates in a wide range of immunization-related activities. On the domestic front, AID representatives participate as liaison members to the NVP's National Vaccine Advisory Committee (NVAC). In addition, they sit on the U.S. Department of Health and Human Services' NVP Interagency Group, whose membership comprises senior scientific and policy officials from AID, CDC, DOD, FDA, NIH, and NVP and is charged with overseeing implementation of the NVP.

AID's vaccine-related initiatives are international in scope. The bulk of AID resources supports national EPI programs and is provided through bilateral agreements. Since 1986, AID has committed an estimated $246 million for immunization programs and vaccine-related research to more than 60 countries (U.S. Agency for International Development, 1992). In 1991, AID allocated over $15 million for the development and testing of vaccines (Institute of Medicine, 1991; U.S. Agency for International Development, 1992). AID funds also support the development, testing, and introduction of diagnostics and immunization-related technologies intended to simplify vaccine administration and improve the ''cold chain" (the system needed to keep vaccines refrigerated from manufacture to administration). AID has provided extensive support to strengthen the developing world's capacity for vaccine testing and delivery and for disease surveillance. The agency funds the development of epidemiological and research capacity in



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