state (the hold harmless conditions); developing an appropriate set of proxy measures that reflect need, capacity, and performance in the field of immunization; and choosing the appropriate multiyear finance mechanism for the allocation of federal funds. This work should begin immediately if its results are to be available when needed.

Recommendation 6: Federal and state agencies should develop a set of consistent and comparable immunization measures for use in monitoring the status of children and adults enrolled in private and public health plans.

Assessments of these rates should allow state and federal governments to monitor immunization levels and identify disparities in need, capacity, and performance over time and among regions, including small geographic areas and selected health plans (e.g., Medicaid, SCHIP, and private insurance). A small set of comparable measures that can harmonize the Health Plan Employer Data and Information Set and the National Immunization Survey, for example, will allow federal and state agencies to monitor state need, capacity, and performance without imposing unnecessarily burdensome reporting efforts on the states that would restrict their ability to use federal funds productively in responding to local circumstances. Such measures can also facilitate efforts by state and federal health officials to assess the quality of primary-care health services within private-sector health plans, so that public health agencies can direct appropriate resources to areas in which private-sector plans do not have sufficient capacity to meet health care needs. The use of consistent immunization measures offers benefit not only for immunization efforts, but also for other national programs that require national investments in primary health care.



Section 317 of the Public Health Service Act authorizes federal grants to the states to assist them in meeting the costs of preventive health services programs for immunization. The program includes grants for vaccine purchase as well as for the development of state infrastructure efforts. This study was requested in U.S. Senate Report 105–300 to accompany S. 2440 (Departments of Labor, Health and Human Services, and Education and Related Agencies Appropriations Bill), which directed CDC to contract with the Institute of Medicine to conduct an evaluation of the recent successes, resource needs, cost structure, and strategies of immunization efforts in the United States.


ACIP approval of the pneumococcal conjugate vaccine occurred after the IOM committee formulated its vaccine purchase recommendations and is not reflected in this calculation.

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