these goals depends on developing better information and information tools that make it possible to identify the unmet needs for immunization and to evaluate the impact of steps taken to meet those needs. More fundamentally, improved immunization coverage of preschool children requires a population-based approach to the overall issue of primary care that combines the efforts of private health care providers and a public health system capable of assessing the health of communities, developing public health policy, and assuring that necessary services are provided.

As the nation debates health care reform, the promise for preventing illness with vaccines contrasted with the poor immunization rates of preschool children offers an important lesson about the provision of preventive health services. As effective as preventive services such as immunizations are when they are administered, simply making them available through private providers and public health clinics does not guarantee that these services will be used or received by all who need them. The promising approaches to immunization discussed at the workshop indicate the importance of collaboration between the public health system and private medical practice. This population-based approach to improving the health of the public is likely to be successful for other preventive and primary care services as well.