tury, a substantial amount of the infectious disease burden has been reduced because of successes in vaccine development and immunization coverage for each new cohort of children, adolescents, and adults. Since 1900, vaccines have been licensed for use against 21 diseases; 11 of these vaccines have been recommended for use in all U.S. children (Centers for Disease Control and Prevention, 1999a).1 In 1997, basic immunization coverage2 nationwide was 91 percent or higher in children 19–35 months of age; adult influenza coverage in persons 65 and older reached 66 percent (Centers for Disease Control and Prevention, 1999b: 7).

At the request of the U.S. Senate Appropriations Committee, the Institute of Medicine's Committee on Immunization Finance Policies and Practices is examining the nature and cost of the federal role in supporting a national immunization policy.3 The IOM study will review the impact of federal funds on immunization rates and will eventually recommend an appropriate level of future federal investment in achieving national immunization goals, especially in the area of infrastructure support, which represents the set of diverse services and systems separate from vaccine purchase and delivery. 4

In this interim report, the committee has been asked by CDC to examine two specific concerns regarding Section 317 of the Public Health Services Act, which provides federal funds to the states for vaccines and immunization infrastructure efforts:

  • the experience with carryover (unobligated funds) in the administration of the Section 317 program; and

  • The impact of the new Children's Health Insurance Program on the need for federal Section 317 funds for both core function initiatives and vaccine purchase.

Immunization serves two important purposes: protection of the individual and protection of the community by reducing and, in some cases, eliminating the spread of infectious agents. Recognizing that the control of vaccine preventable disease is a national policy matter, the Congress and the federal government have launched a comprehensive strategy over the past four decades to improve immunization rates throughout the nation. This strategy is grounded in the following premises:

  • Vaccines are one of the most cost effective public health interventions of the 20th century. For example, CDC estimates that the U.S. saves over $13 for every dollar invested in measles/mumps/rubella vaccination —a savings of approximately $4 billion each year (CDC, 1999b: 8). Research and science continue to expand and improve our ability to reduce the disease burden against new infectious agents.

  • Each day approximately 11,000 infants are born who should receive between 19 and 23 doses of vaccines to be fully immunized, most of which should be administered by 18 months of age.

  • Although a significant proportion of the general population may be fully immunized at a particular time, coverage rates are uneven and life-threatening disease outbreaks can and do occur. In a highly mobile society, the presence and movement of even small numbers of unimmunized individuals can foster

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