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Calling the Shots: Immunization Finance Policies and Practices
cine purchases have been reported only recently (fiscal year [FY] 1998). The annual budget for the National Vaccine Injury Compensation Fund, administered by the Health Resources and Services Administration (HRSA), adds another $100 million annually to the federal budget, but these funds are reserved solely for injury compensation claims and are not available to support vaccine purchase, service-delivery, or immunization programs. Trend data are not available for other federal investments, such as routine vaccine purchases and administration for military personnel and their families or veterans, or vaccines dispensed through the Indian Health Service. These budgets are designed primarily for clinical services and do not supplement infrastructure efforts within the states. Some immunization services are supported through Title V grants, the Community/Migrant Health Centers grants, and the Public Health Service prevention block grants, but such budgets are not tracked separately, nor are they reported in annual executive and congressional summaries of federal expenditures for immunizations.
The proliferation of new federal funding sources for vaccine purchase and child health care services (including VFC and SCHIP) raises the question of whether these new programs have the capability to assume many functions previously supported by Section 317 funds. These newer programs have absorbed many of the costs of vaccine purchases and office visits previously covered by Section 317 or Medicaid. Even with the expansion of public and private health plans, however, pockets of need remain in which individuals are susceptible to vaccine-preventable diseases. In addition, the increasing number of new vaccines, the fragmentation of uncovered groups, and the shift to private health care providers have increased the complexity of the national immunization system, requiring additional infrastructure and oversight within the states. As Medicaid, SCHIP, and other new federal programs are fully implemented, they may be able to absorb greater responsibilities in areas such as provider audits, assessments, outreach, and education for underserved populations and their health care providers. At present, however, these newer federal programs are not designed to perform or finance these roles.
The total amount of state funds allocated for immunization activities in the 1990s is not available. In 1999, CDC required state immunization agencies to estimate other federal (non-Section 317) funds, state funds, and private sources scheduled to support their immunization efforts in calendar year (CY) 2000. Based on these self-reported data, CDC has estimated that state budgets allocate a total of about $340 million for immunization programs and services, which include vaccine purchase and infrastructure support (information provided by CDC). This figure includes a variety of revenue sources, including state-only spending, reallocated federal budgets, and intergovernmental transfers, including school health.