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Calling the Shots: Immunization Finance Policies and Practices
When Section 317 grant awards were reduced, state expenditure rates gradually increased, demonstrating the states’ growing capacity to use federal funds for immunization services. The states’ needs eventually became greater than the resources available to them. Expenditure rates of the infrastructure grants during 1997 and 1998 were in the range of 86 percent and 96 percent, respectively, and total carryover of funds is currently estimated at less than $10 million for 1998 Section 317 FA awards. CDC and state officials now report that the current level of federal funds for Section 317 infrastructure support (requested at $117 million for FY 2000) is no longer sufficient to support their efforts (Thompson, 1998).
Global Polio Eradication Initiative. Reasoning that the health and economic benefits of polio eradication would be perpetual and that extra funds would be needed for a few years only to achieve this goal, CDC launched a global polio eradication initiative in 1996, with congressional support. The initiative involved an extensive partnership (including funding and technical support) with Rotary International, the United Nations Foundation, the United Nations International Children’s Emergency Fund (UNICEF), the World Health Organization, and governments of other industrialized countries.
In the period FY 1996–1998, when budget cutbacks were common throughout DHHS, CDC received explicit guidance from both the House of Representatives and the Senate to fund the new initiative for polio eradication (as well as measles elimination) at the expense of state vaccine purchase and infrastructure development funds (U.S. House of Representatives, 1996). Recognizing that prior increases had occurred in the state infrastructure grants, and disturbed by reports of large amounts of unspent state funds from prior years, the Congress expressed strong support for the global polio eradication program and encouraged CDC to expand the effort using available resources—by reducing the state infrastructure grant awards. This decision to cut the base of the state infrastructure program to support the global polio eradication effort plays an important role in explaining the shortfall now being experienced by the states.
Impact of Budget Reductions
Reductions in state infrastructure grants have affected each of the six key roles of the national immunization system. For example:
Infectious disease prevention and control—At present, the NIP does not have a separate pool of funds within the Section 317 grant program to support the purchase of vaccines for outbreak control (information pro-