BOX 6–1 Conclusions and Recommendations

CONCLUSIONS

Conclusion 1: The repetitive ebb and flow cycles in the distribution of public resources for immunization programs have created instability and uncertainty that are eroding the continued success of immunization activities.

Conclusion 2: Immunization policy needs to be national in scope. At the same time, the implementation of immunization policy must be flexible enough to respond to special circumstances that occur at the state and local levels.

Conclusion 3: Federal and state governments each have important roles in supporting not only vaccine purchase, but also infrastructure efforts that can achieve and sustain national immunization goals.

Conclusion 4: Private health care plans and providers have the capacity to do more in implementing immunization surveillance and preventive programs within their health practices, but such efforts require additional assistance, oversight, and incentives. At the same time, comprehensive insurance and high-quality primary care services do not replace the need for public health infrastructure.

SUMMARY RECOMMENDATIONS

Recommendation 1: The annual federal and state budgets for the purchase of childhood vaccines for public health providers appear to be adequate, but additions to the vaccine schedule are likely to increase the burden of effort within each state. Therefore, the committee recommends that CDC be required to notify Congress each year of the estimated cost impact of new vaccines that have been added to the immunization schedule so that these figures can be considered in reviewing the vaccine purchase and infrastructure budgets for the Section 317 program.

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.

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.

Recommendation 4: Congress should improve the targeting and stability of Section 317 immunization grant awards to the states by replacing the current discretionary grant award mechanism with formula grant legislation.

Recommendation 5: CDC should initiate a dialogue with federal and state health agencies, state legislatures, state governors, and the U.S. Congress immediately so that legislative and budgetary reforms can be proposed promptly when Section 317 is up for reauthorization in FY 2002.

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.



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