(2) the length of time that may be involved from the point at which such vaccines are recommended by the Advisory Committee on Immunization Practices (ACIP) to the establishment of a VFC contract. Federal and state vaccine purchase budgets should then be adjusted as necessary.

Recommendation 2: Additional funds are needed to purchase vaccines for uninsured and underinsured adult populations within the states. The committee recommends that Congress increase the annual Section 317 vaccine budget by $50 million per year to meet residual needs for high-risk adolescents and adults under age 65 who do not qualify for other federal assistance. The committee further recommends that state governments likewise increase their spending for adult vaccines by $11 million per year.

These estimates are based on calculations of the residual vaccine needs for uninsured at-risk populations, including adults who are younger than age 65 and suffer from chronic disease; for hepatitis B coverage among adolescents; for adults who are at risk because of sexual behavior or occupational settings; and for tetanus coverage for unprotected adults. Both federal and state vaccine purchase budgets will require annual adjustments as vaccine costs change or new vaccines or age groups are added to the adult immunization schedule. Therefore, CDC notification of the impact of such changes should be required annually, as indicated in Recommendation 1.

The improvement of adult immunization rates will require more than increased vaccine purchases. A comprehensive and coordinated adult immunization program needs to be initiated within each state, with leadership at the national, state, and local levels, to encourage the participation of private and public health care providers in offering immunizations to adults under the guidelines established in the ACIP schedule.

Recommendation 3: State immunization infrastructure programs require increased financial and administrative support to strengthen immunization capacity and reduce disparities in child and adult coverage rates. The committee recommends that states increase their immunization budgets by adding $100 million over current spending levels, supplemented by an annual federal budget of $200 million to support state infrastructure efforts.

The committee believes state immunization programs could achieve stability and carry out their roles adequately through the adoption of a

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