The reduced financial barriers to primary care expected with health care reform should give the United States an opportunity to apply some lessons from the highly successful immunization program in the United Kingdom. There, every child is registered in a health district and is assigned to a primary care provider. Each provider is accountable for the immunization status of all children assigned to the practice and receives substantial incentive payments for achieving specific levels of immunization coverage among those children. Even with health care reform, however, the United States will not have a system comparable to the United Kingdom's unified National Health Service through which to work. Primary care will continue to be provided by a mix of providers in the public and private sectors. The United States also does not currently have a comprehensive registry system that can account for the immunization status of every child. Such differences will make it more complicated to establish the population-based accountability and rewards that are so important in the U.K. program.

  • The United States cannot wait for health care reform to address its immunization problems. Although enactment of major health care reform measures appears likely, no one can be certain when they will take effect or what their final form will be. In the meantime, over 4 million children are being born each year. At current levels of immunization, about 1 million of them join the pool of underimmunized preschool children who remain susceptible to serious illnesses. Furthermore, health care reform is not necessary to begin improving immunization rates among preschool children. Steps such as those discussed at the workshop—that some states, communities, and providers are already taking—can make important contributions to more complete immunization coverage.


This report reflects the committee's assessment of the problem of underimmunization and the scope of the response that is needed. It makes no formal recommendations, but it draws on the analysis, experience, and insight of workshop participants to identify opportunities to achieve more complete immunization of preschool children in the near term. Other improvements may take longer to implement or will depend on the enactment of anticipated health care reform measures.

Readers familiar with immunization issues will find in this report much that has been said before. The value of both the workshop discussions and this report lies in reiterating the seriousness of the problem of underimmunization and emphasizing the special importance of nonfinancial barriers to immunization. In particular, the report emphasizes establishing accountability for delivery of

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