reduce serious disparities between public and private health plan benefits. Public health agencies should not be expected to supplement immunization benefits within public or private health insurance plans except under short-term conditions, such as emergency outbreaks or “catch-up” conditions following the licensing of new vaccines.

In addition to vaccine coverage benefits, health plan providers can assess immunization coverage rates among their enrollees in ways that can contribute to accurate community health profiles at the state and local levels. These efforts require independent oversight, however, to assure that all groups are included in such assessments, including those populations that are not currently enrolled in public and private health plans. Public health agencies can provide important measurement and audit services, such as assessment and feedback for private providers, as an investment in the quality of community health.

RECOMMENDATIONS

The financial components of the following six recommendations are summarized in Table ES-1.

Recommendation 1: The annual federal and state budgets for the purchase of childhood vaccines for public health providers appear to be adequate, but additions to the vaccine schedule are likely to increase the burden of effort within each state. Therefore, the committee recommends that CDC be required to notify Congress each year of the estimated cost impact of new vaccines that have been added to the immunization schedule so that these figures can be considered in reviewing the vaccine purchase and infrastructure budgets for the Section 317 program.

The committee believes the annual allocation of federal funds for the purchase of vaccines through the VFC program ($505 million for FY 2000) and the Section 317 state grant program ($162 million per year for FY 2000) is sufficient to meet state requests for child vaccines within the immunization schedule recommended by ACIP as of January 2000.2 But additions to the ACIP schedule will expand the burden of preventive health care costs to state and federal health agencies as well as private health plans.

Congress should anticipate such cost increases by requiring that CDC notify Congress each year of two trends: (1) the estimated cost impact of new vaccines (including administration fees) that are scheduled for consideration as additions to the recommended immunization schedule, and



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