9The amount of funds available for infrastructure services within the Section 317 grants in 1997 and 1998 is less than half of what was appropriated in 1996. See Table 2.

10F.E. Thompson, 1998. Letter to DHHS Secretary Shalala. December 23. Washington, DC: Association of State and Territorial Health Officials.

11Institute of Medicine. 1994. Overcoming Barriers to Immunization. Washington, DC: National Academy Press. p. 3.

12See, for example, letter from the Association of State and Territorial Health Officials to Secretary Donna Shalala (Thompson, 1998): “The severe cuts (upwards of 60%) to infrastructure over the last two years have resulted in major cutbacks on the state level including: reductions in every aspect of programs, from development of materials to staffing of clinics; cancellations of contracts with WIC, private providers, community health centers, TANF, and community coalitions; severe reductions in registry development and maintenance; reductions in clinic hours and the delivery of shots; and cancellation of assessment programs, evaluation and surveillance improvements. In addition the severe cutbacks do not allow for states to plan and implement the institutionalization of vaccine delivery strategies that work…”. Washington, DC: Association of State and Territorial Health Officials. Proposed reductions in state efforts have also been described in materials provided by the CDC to the National Vaccine Advisory Committee (CDC, 1999d).

13See for example, S. Richardson, 1998, letter to state health officials. May 11. Washington, DC: Health Care Financing Administration.

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