The committee's assessments rest on several assumptions about immunization and immunization services. First, all children in the United States should receive the recommended and medically appropriate immunizations at the recommended times to protect their own health and that of the community. Immunization is one of the safest and most cost-effective means of preventing illness. Second, the environment for vaccine delivery is rapidly changing: the introduction of new and reformulated vaccines, federal purchase of vaccines for Medicaid-eligible and uninsured children beginning in October 1994, adoption of managed care plans by state Medicaid programs, and probable passage of health care reform legislation.

Third, immunization can best be seen as part of comprehensive primary care. A freestanding “immunization system” is not an appropriate objective. Finally, the United States cannot wait for health care reform to address its immunization problems. No one can be certain when health care reform measures will take effect or what their final form will be. In the meantime, of the more than 4 million children born each year, about 1 million join the pool of underimmunized preschool children who remain susceptible to serious illness.


The committee concluded that efforts to improve immunization rates among preschool children should focus on (1) leadership for action on immunization, (2) accountability and responsibility for providing immunizations, (3) support for improving provider practices, (4) effective communication with families and the community, and (5) development of better information and more effective information tools to support each of the other efforts.


No easily delineated system of primary care exists. Providers in the public and private sectors deliver varying sets of services, under diverse systems of compensation, to which families have differing degrees of access. For immunization in particular, no consensus seems to exist as to how responsibility for ensuring that children receive the appropriate care should be shared among parents, providers, payers, and health departments. This can result in gaps in children's care. To overcome these gaps, stronger leadership is needed at the federal, state, and local levels and in the public and private sectors. When the political will to improve immunization levels exists, many financial and bureaucratic barriers can be overcome.

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