these contributions over time, and provide an opportunity for CDC to review how federal and state funds are distributed across the six roles of the immunization system discussed in this report. It is conceivable that a match requirement might prompt individual states to add their own resources or in-kind contributions to their immunization programs, or to seek such resources from outside government, since health officers will need to demonstrate a base level of grantee contribution to qualify for federal grants.

CDC has always stressed that federal funding is to be used to supplement, not supplant, each grantee’s immunization effort, but a state-level contribution is not currently required for Section 317 grants. Such grants originated in a public health environment in which it was assumed that a state match requirement would delay the use of federal funds in swiftly reducing exposure to vaccine-preventable diseases for vulnerable populations. Over time, however, immunization has become a routine part of primary care services that are financed in large measure through cooperative state and federal arrangements. Additional assessment and populationwide services have also increased the costs of sustaining and improving up-to-date coverage within the U.S. population as a whole, and the federal government should not be expected to support these costs alone.

The committee considered several arguments against a state match, but did not find them compelling. Following are these arguments and the committee’s response to each.

First, a matching requirement would necessitate changing the existing Section 317 legislation, and exposure of the legislation and approvals of annual budgetary contributions within the states could generate skepticism about the infrastructure grants program and create vulnerabilities in the political process. The committee believes broader exposure of the immunization grants program will strengthen federal and state collaboration. Although the legislative reform process may introduce undesirable or radical changes in the program’s scope, purpose, or funding approach that could create uncertainty and confusion and disrupt programmatic efforts, at least in the short term, a state match requirement is not likely to have this effect provided the rationale for the match is sound and justified.

Second, a state match requirement might create incentives for government officials or legislators to reduce grantee contributions in areas in which the match is already exceeded. In other areas, state or local public health officials or legislators might not be able or inclined to meet a matching requirement, and federal grants could be reduced or eliminated as a result. If state contributions to public health are invested wisely, evidence should be available to demonstrate why such contributions are in the state’s interest.

Third, administering a state match requirement will require additional docu-



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