• the Nation's immunization efforts are important and deserve careful attention,

  • the current state of flux in new federal programs (such as CHIP) is generating considerable uncertainty about the role of governmental efforts in supporting and financing immunization services,

  • as an insurance program, CHIP is not designed to support population-wide services in areas such as assessment of immunization coverage, professional and public education about vaccines, record assessment, or the development of immunization registries; and

  • states have the capacity to use at least the current level of federal support from the national immunization program productively; any further reductions would threaten the provision of needed immunization services and would add further instability to a system in flux.

The task of immunizing the population of the United States is the responsibility of individual medical practitioners, state and local governments, and private organizations that constitute the decentralized health care system within this country. Reliance upon a patchwork health care system to provide immunization, and uneven and inconsistent investments in public health infrastructure foster circumstances in which ample opportunity exists for confusion and uncertainty in sustaining high levels of immunization coverage. Interactions among federal entitlements and discretionary programs, cost reimbursement policies, tax revenues, market forces, regulatory practices, and financial incentives all can contribute to—or impede—improvements in immunization rates. The committee's role will fbe to identify relevant knowledge and datasets that can illuminate the ways in which these interactions occur and guide future federal and state finance strategies for immunization efforts.

The committee recognizes that the mixture of public and private resources that undergirds the Nation's vaccine delivery system provides important lessons regarding the appropriate scope and limitations of public finance efforts. Increasingly, the public demands that we carefully balance governmental interventions against the role of the private health care sector. Some approaches may be more effective than others in achieving improvements in immunization coverage rates, and activities that are more appropriate for performance within the private sector should not be duplicated within government. Not all infrastructure efforts within the states require federal investments, but at present no strong methodology is available to distinguish among the priorities and areas of need included in the state budgetary requests. The committee 's final report will seek to identify knowledge about and experience with infrastructure roles and practices so that federal investments in immunization can be guided by data analysis, experience, and informed insights.

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