their implementation across multiple populations. Policy linkages are also needed to strengthen system performance and to bridge gaps between the health care finance and health care delivery systems. System-level interventions can improve immunization coverage rates when they benefit key target audiences, but such interventions can be difficult to achieve when their implementation requires changes in professional behavior or organizational practices.

Ongoing developments within the science of vaccines, changes in the organization of the U.S. health care system, and movements within the population at large all place extraordinary demands on the public health infrastructure for immunization (see Chapter 2). These demands, in turn, have generated two key forces: (1) a persistent national need for the best available expertise, technology, tools, and leadership to complement state efforts to fulfill important public health functions, and (2) a strong desire to maintain flexibility in services and policies at the state and local levels to ensure responsiveness to immediate situations and state-driven priorities. These twin forces shape the infrastructure for immunization nationwide.

Finding 4–14. The immunization infrastructure within each state needs to have the capacity to perform a set of critical surveillance, disease control, safety oversight, and immunization improvement strategies to sustain current coverage rates. Reductions in this capacity will contribute to a weakening of vaccination levels and possible disease outbreaks.

Chapter 5 considers the various forms of local, state, and federal investments in each of the three roles discussed in this chapter. Recognizing that variations in organizational style can affect the level of resources required, we examine how some states have spent federal funds to support stand-alone as well as integrated services. Determining the level of resources necessary to sustain a viable and flexible infrastructure and how such investments should be allocated across state and national budgets is essential to ensure a viable, flexible, and stable national immunization system in the future. The particular roles and contributions of the National Immunization Program and Section 317 funds are considered in this context.



Diphtheria, tetanus, and pertussis (DTP) vaccine; poliovirus vaccine; measles, mumps, and rubella (MMR) vaccine; Haemophilus influenzae type b vaccine; and hepatitis B vaccine.


Up-to-date coverage is calculated for children at the 24-month mark. However, the retrospective nature of this survey results in a 3-year lag time in the data reported. Thus, for

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