• Many states had difficulty predicting the level of funding for any given year, making it problematic to create accurate budgets or engage in strategic planning for the immunization program.

  • The program year according to which CDC awards Section 317 grants is the calendar year. This matches no state fiscal year; most states’ fiscal years (46) run from July through June, with state legislative action taking place earlier in the spring. State legislatures must thus make program and budget decisions knowing only the federal award for the first 6 months (July through December) of their upcoming fiscal year.

  • Statewide hiring freezes and other administrative policies prohibited immunization programs from hiring full-time permanent staff.

  • CDC grants were commonly allocated in a piecemeal way, including multiple grants within a budget cycle and the distribution of funds late in the fiscal year.

  • States with cumbersome internal procedures for budgeting, spending, or hiring were unable to spend all their funds within a calendar year.

  • Some state legislatures meet biennially, causing delays in accommodating additional unanticipated federal grants.

  • Funds increased more quickly than states’ capacity to use them, so states retained the funding as carryover until they had established the plans and personnel necessary to implement new programs reflecting their additional responsibilities.

Many states carried forward significant amounts of federal funds from one budget cycle to the next. In 1996, for example, carryover funds represented almost half of the total federal immunization funding to the states. Congress viewed the carryover funds as excessive, and over the period FY 1996–1998 reduced the base for Section 317 infrastructure funding by almost 50 percent, from $271 million in FY 1995 to $139 million in FY 1999 and 2000 (of which about $117 million is available for actual state grant awards). Most state officials have indicated that the budget reductions occurred precisely at the point at which they believed they had made significant strides in the organization of immunization delivery and other activities (Freed et al., 1999).

In response to the budget cuts, most states reduced the scale of effort of their activities, commonly reducing outreach, education efforts, and service-delivery arrangements with outside contractors. Half of the states have reported that the budget cuts affected staffing, requiring them to reduce staff, consolidate positions, or leave vacancies unfilled (Freed et al., 1999).

States have access to other direct or indirect funding sources for infrastructure, but such funds are focused primarily on specific project efforts rather than general support. Vaccine manufacturers have assisted with

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