Overcoming Barriers to Immunization

A Workshop Summary

Jane S. Durch, Editor

Committee on Overcoming Barriers to Immunization

Division of Health Promotion and Disease Prevention

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.
1994


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Overcoming Barriers to Immunization: A Workshop Summary Overcoming Barriers to Immunization A Workshop Summary Jane S. Durch, Editor Committee on Overcoming Barriers to Immunization Division of Health Promotion and Disease Prevention INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C. 1994

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Overcoming Barriers to Immunization: A Workshop Summary NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W.Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. Funding for this project was provided by the Carnegie Corporation of New York under grant D 93031 and the National Immunization Program of the Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, under grant R13/CCR310159-01. The views presented are those of the Institute of Medicine Committee on Overcoming Barriers to Immunization and the participants in the workshop and are not necessarily those of the funding organizations. Additional copies of this report are available from: Division of Health Promotion and Disease Prevention Institute of Medicine 2101 Constitution Avenue, N.W. Washington, DC 20418 Copyright 1994 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemusseen in Berlin.

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Overcoming Barriers to Immunization: A Workshop Summary COMMITTEE ON OVERCOMING BARRIERS TO IMMUNIZATION LORRAINE V. KLERMAN( Chair), Professor and Chairperson, Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama PHYLLIS FREEMAN, Associate Professor, Law Center,and Senior Fellow, John W. McCormack Institute of Public Affairs, University of Massachusetts, Boston, Massachusetts FERNANDO A. GUERRA, Director of Health, San Antonio Metropolitan Health District, San Antonio, Texas KAY A. JOHNSON, Director, Policy and Government Affairs, March of Dimes Birth Defects Foundation, Washington, D.C. EDGAR K. MARCUSE, Director, Ambulatory Care Services, Children's Hospital and Medical Center, Seattle, Washington PATRICIA DOLAN MULLEN, Professorand Deputy Director, Center for Health Promotion Research and Development, The University of Texas Health Science Center/Houston, Houston, Texas ROBERT K. ROSS, Director, Department of Health Services, County of San Diego, San Diego, California HENRY R. SHINEFIELD, * Emeritus Chief of Pediatricsand Co-Director, Vaccine Study Center, The Permanente Medical Group, San Francisco, California Institute of Medicine Staff JANE S. DURCH, Study Director SARAH S. BROWN, Senior Program Officer LINDA A. DePUGH, Administrative Assistant MICHAEL A. STOTO, Director, Division of Health Promotion and Disease Prevention *Institute of Medicine member.

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Overcoming Barriers to Immunization: A Workshop Summary WORKSHOP SPEAKERS ROGER BERNIER, Centers for Disease Control and Prevention, Atlanta, Georgia STEVEN BLACK, Northern California Kaiser Permanente, Oakland, California EUGENE DINI, Centers for Disease Control and Prevention, Atlanta, Georgia JAMES FEIST, Private Practice (Pediatrics), Bozeman, Montana JEFFREY GOLDHAGGEN, Duval County Public Health Department, Jacksonville, Florida RITA GOODMAN, Health Resources and Services Administration, Rockville, Maryland ELIZABETH HOLT, The Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland CHRISTOPHER KOEPKE, Albert Einstein Medical Center, Philadelphia, Pennsylvania ALAN KOHRT, Private Practice (Pediatrics), Honesdale, Pennsylvania SUSAN LETT, Massachusetts Department of Public Health, Boston, Massachusetts TRACY LIEU, Northern California Kaiser Permanente, Oakland, California HERMINIA LUNA, Chicago Department of Health, Chicago, Illinois ROSE ANN MEINECKE, Maryland Department of Health and Mental Hygiene, Baltimore, Maryland WALTER ORENSTEIN, Centers for Disease Control and Prevention, Atlanta, Georgia CARMEN PARIS, Philadelphia Department of Public Health, Philadelphia, Pennsylvania MAGDA PECK, CityMatCH, Omaha, Nebraska ANTHONY ROBBINS, National Vaccine Program Office, Washington, D.C. LANCE RODEWALD, University of Rochester School of Medicine and Dentistry, Rochester, New York IRWIN ROSENSTOCK, University of Michigan (emeritus), Sarasota, Florida DAVID SALISBURY, Department of Health, London, United Kingdom DAVID SIEGEL, Health Alliance Plan of Michigan, Detroit, Michigan DAVID SMITH, Texas Department of Health, Austin, Texas PETER SZILAGYI, University of Rochester School of Medicine and Dentistry, Rochester, New York THOMAS VERNON, Merck & Company, Inc., West Point, Pennsylvania DAVID WOOD, UCLA School of Medicine, Los Angeles, California

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Overcoming Barriers to Immunization: A Workshop Summary PARTICIPANTS BARBARA ALIZA, Association of Maternal and Child Health Programs, Washington, D.C. LUCY ANDRIS, Healthy Mothers, Healthy Babies Coalition, Washington, D.C. ALLAN ARBETER, Albert Einstein Medical Center, Philadelphia, Pennsylvania NORMA DAVIES BALL, Special Nutrition Program, U.S. Department of Agriculture, Washington, D.C. PETER BOUXSEIN, National Vaccine Program Office, Washington, D.C. JOEL BREMAN, National Vaccine Program Office, Washington, D.C. EDWARD BRINK, Centers for Disease Control and Prevention, Atlanta, Georgia ROBERT COSBY, Metropolitan Washington Council of Governments, Washington, D.C. CIRO A. DE QUADROS, Pan American Health Organization, Washington, D.C. AMY FINE, Association of Maternal and Child Health Programs, Washington, D.C. JUANITA FLEMING, University of Kentucky, Lexington, Kentucky PAULA FRANKLIN, Children's Defense Fund, Washington, D.C. ELIZABETH GOSS, Fox, Bennett & Turner Law Firm, Washington, D.C. BURTON HALPERT, Cooperative Extension Service, U.S. Department of Agriculture, Washington, D.C. JAMES HANSON, National Vaccine Program Office, Washington, D.C. CYNTHIA HOWE, Institute of Medicine, Washington, D.C. NANCY HUGHART, The Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland RUTH KATZ, Committee on Energy and Commerce, U.S. House of Representatives, Washington, D.C. LAURA KAVANAGH, National Center for Education in Maternal and Child Health, Arlington, Virginia NANCY KELLEY, Office of Senator Dale Bumpers, Washington, D.C. MARY RUPP KOPP, Kansas State Nurses Association, Topeka, Kansas HOWARD W. KROLL, Health Resources and Services Administration, Rockville, Maryland CAROL LOGAN KUHNS, National Center for Education in Maternal and Child Health, Arlington, Virginia SHEREE CHIN LEDWELL, Group Health Association of America, Washington, D.C. ADORA LEE, Academy for Educational Development, Washington, D.C.

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Overcoming Barriers to Immunization: A Workshop Summary JODIE LEVIN-EPSTEIN, Center for Law and Social Policy, Washington, D.C. MARY McCALL, Association of State and Territorial Health Officials, Washington, D.C. LAURIE MICHEL, Connaught Laboratories, Inc., Washington, D.C. PAMELA MITTELSTADT, Group Health Association of America, Washington, D.C. LYN MORTIMER, Carnegie Corporation of New York, Washington, D.C. ELENA NIGHTINGALE, Carnegie Corporation of New York, Washington, D.C. AUDREY NORA, Health Resources and Services Administration, Rockville, Maryland DENNIS O'MARA, Centers for Disease Control and Prevention, Atlanta, Georgia JEANNE PRIESTER, Cooperative Extension Service, U.S. Department of Agriculture, Washington, D.C. REGINA RABINOVICH, National Vaccine Program Office, Washington, D.C. H. R. SHEPHERD, Armstrong Pharmaceuticals, Inc., New Canaan, Connecticut WILLA SIEGEL, Administration for Children and Families, U.S. Department of Health and Human Services, Washington, D.C. KIMBERLY SPAULDING, Labor and Human Resources Committee, U.S. Senate, Washington, D.C. PAUL STEHR-GREEN, Centers for Disease Control and Prevention, Atlanta, Georgia DAVID STEVENS, Health Resources and Services Administration, Rockville, Maryland RON TESKE, Centers for Disease Control and Prevention, Atlanta, Georgia WILLIAM WATSON, JR., Task Force for Child Survival, Atlanta, Georgia ELIZABETH WEHR, Center for Health Policy Research, Washington, D.C. RICHARD ZIMMERMAN, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

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Overcoming Barriers to Immunization: A Workshop Summary Acknowledgments The workshop steering committee and staff would like to acknowledge assistance from several individuals and organizations. The Institute of Medicine (IOM) obtained initial funding for this project from the Carnegie Corporation of New York. Additional funds were provided by the National Immunization Program (NIP) at the Centers for Disease Control and Prevention. Many members of the NIP staff provided assistance. Walter Orenstein, NIP Director, and Paul Stehr-Green, project officer for the workshop, were particularly helpful. The project also benefited from funds made available through the IOM's Board on Health Promotion and Disease Prevention. The National Vaccine Program Office played an important role in encouraging IOM to undertake this project; Anthony Robbins and James Hanson, in particular, provided valuable guidance. Critical to the success of the workshop was the active and thoughtful participation of 26 speakers and some 40 other attendees, who are listed in the rosters at the beginning of the report. Other individuals who did not attend the workshop also provided assistance: Roger Barkin, Rose Medical Center, Denver; Virginia Burggraf, American Nurses Association; Linda Talbot, Every Child By Two; and Herbert Young, American Academy of Family Physicians. The workshop was conducted in cooperation with the Board on Children and Families (Deborah Phillips, Director), which operates through both the National Research Council and the IOM. Reviewers from the Board on Health Promotion and Disease Prevention and the Board on Children and Families contributed constructive comments. Michael Hayes provided helpful editorial assistance. Several IOM staff members made valuable contributions to planning and

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Overcoming Barriers to Immunization: A Workshop Summary conducting the workshop and preparing the report: Sarah Brown, Claudia Carl, Michael Edington, Judith Doody, Polly Harrison, Cynthia Howe, Carrie Ingalls, Dorothy Majewski, Violaine Mitchell, and Gail Spears. Linda DePugh provided essential administrative and logistical support throughout the project. Michael Stoto, Director of the Division of Health Promotion and Disease Prevention, guided the project from its inception.