cult as a result of decreased exposure to information on the need for immunizations, as well as the complexities involved in documenting increasing numbers of vaccines across the life span.

ENDNOTES

1.  

A 1997 survey of employer-sponsored health plans (Partnership for Prevention/ William Mercer Survey) indicated that 82 percent of employers’ most popular health plans (i.e., the plans with the highest employee enrollment) provided immunization benefits for infants and children, while 71 percent provided coverage of immunizations for adolescents. The survey also indicated that adult vaccines are least likely to be covered: 57 percent of employers’ most popular health plans included coverage for influenza vaccines, while only 41 percent covered pneumococcal vaccines.

2.  

Data collected by the Health Insurance Association of America (HIAA) show that between 1989 and 1992, immunization as a benefit covered by conventional insurance plans increased from 45 to 53 percent, by preferred provider organization plans increased from 62 to 65 percent, and by health maintenance organization plans decreased from 98 to 95 percent (information provided by HIAA).

3.  

The harmonized schedule is endorsed by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP).

4.  

These metropolitan regions represent the remnant of a larger group of urban grantees once associated with the Section 317 program.

5.  

CASA is a menu-driven relational database developed by CDC as an assessment tool for immunization clinics and providers. CASA provides programmatic feedback that can highlight areas that may have lower levels of immunization coverage, identify the up-to-date immunization status of the age group served by the clinic or practice, describe antigen-specific levels, and disclose the proportion of children that has dropped out of the vaccination schedule or experienced missed opportunities. CASA can also generate reminder and recall letters and postcards for a specified facility.

6.  

This one-time transfer occurred in the middle of the budgetary cycle and contributed to the carryover problem in the state grants. States were not able to expend these funds expeditiously and reported them as carryover, and the vaccine transfer funds inflated the infrastructure budget for several subsequent years.

7.  

See, for example, a letter from the Association of State and Territorial Health Officials to DHHS Secretary Donna Shalala (Thompson, 1998): “The severe cuts (upwards of 60%) to infrastructure over the last two years have resulted in major cutbacks on the state level including: reductions in every aspect of programs, from development of materials to staffing of clinics; cancellations of contracts with WIC, private providers, community health centers, TANF, and community coalitions; severe reductions in registry development and maintenance; reductions in clinic hours and the delivery of shots; and cancellation of assessment programs, evaluation and surveillance improvements. In addition the severe cutbacks do not allow for states to plan and implement the institutionalization of vaccine delivery strategies that work….” Proposed reductions in state efforts have also been described in materials provided by CDC to NVAC (information provided by CDC).

8.  

Such groups included Rotary Clubs (2 states), McDonald’s (2 states), United Way (1 state), and other private foundations (2 states).

9.  

Senator Durbin (D-IL) and Senator Reed (D-RI) introduced S.2444 in April 2000 to require such coverage through amendments to the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986.



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