States with large areas of concentrated poverty or populations that lack immunization as a result of underinsurance may require additional federal resources to coordinate data collection efforts, to conduct targeted assessments, and to synthesize the collection of records that are scattered across diverse health care settings.

Finding 5–13. States had provided more than $300 million to support immunization efforts as of midsummer 1999. While half the states (25) directly support infrastructure, only 4 states fund a substantial portion of their infrastructure budget (i.e., more than 40 percent). Twenty-one states currently provide no direct state support for immunization infrastructure. Four states receive such funding only by drawing on vaccine purchase funds provided by their legislatures.

Finding 5–14. Some states have identified other finance sources to support immunization services, and new private-sector sources may eventually emerge that can contribute to state programs. However, these other sources are limited in scope and are restricted to particular initiatives, such as the development of registries, education for providers, or community partnership efforts.

FEDERAL ROLES AND RESPONSIBILITIES

The National Immunization Program (NIP) within CDC is the primary agency concerned with federal policy and practices in support of state immunization efforts. NIP works with many different agencies and organizations, including other divisions within CDC, HCFA, NVAC, the Health Resources and Services Administration, and the Interagency Committee on Immunization (Rosenbaum et al., 1992; Fine, 1999; Association of Maternal and Child Health Professionals, 1999). In addition, the Departments of Agriculture, Education, and Housing and Urban Development all participate in the development and implementation of federal immunization policies and programs (Kelley et al., 1993). As one report observes: “The diversity of agencies involved is indicative of the importance of immunization to the overall well-being of children and the complexity of providing this service” (Kelley et al., 1993:1).

Although public health is commonly viewed as a primary function of the states, federal interventions have occurred frequently, beginning with the creation of public health hospitals in port cities in 1798 (DHHS, 2000). The federal government has exercised two separate but often overlapping roles in addressing immunization:

  • State assistance—The federal government has consistently sought



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