ments reach out to adult populations and their health care providers regarding immunization practices. Federal and state leadership has been successful in achieving substantial coordination among the various programs devoted to specific childhood vaccine-preventable diseases. Yet the units devoted to adult vaccine-preventable diseases (e.g., influenza, pneumococcal, tetanus/diphtheria, and hepatitis B infections) typically focus on narrow goals and rarely address a comprehensive adult immunization strategy. Increased funding and coordinated programs can begin to move adult immunization beyond its current marginal status.

In the recommendations at the end of this chapter, the committee proposes a specific financing level for purchasing vaccines as part of an adult immunization program. In addition, the committee recommends that CDC develop a coordinated and comprehensive immunization effort for adults to encourage greater participation by the private and public health care sectors in achieving national goals.

CONCLUSIONS

Conclusion 1: The repetitive ebb and flow cycles in the distribution of public resources for immunization programs have created instability and uncertainty that impeded project planning at the state and local levels in the late 1990s, and delayed the public benefit of advances in the development of new vaccines for both children and adults. This instability now erodes the continued success of immunization activities.

The national immunization system that emerged in the United States in the latter half of the 20th century was created by a series of infectious disease outbreaks and governmental responses, with governmental assistance often being increased after outbreaks occurred, not to prevent them (Johnson et al., forthcoming). Substantial progress has been made in preventing and controlling disease, ensuring access to vaccines, and providing service delivery in medical homes. But three other areas require attention in renewing the national immunization partnership: improving the quality of immunization surveillance efforts and vaccine safety programs, strengthening efforts to sustain and improve immunization coverage rates, and using primary care and public health resources efficiently. The instability of funding for state immunization programs discourages the development of strategic responses designed to foster disease prevention, improve immunization coverage levels for specific populations, and ensure vaccine safety. Diminishing resources often divert attention toward protecting individual programs or interventions rather than focusing on the health and vitality of the population as a whole. The current situation is characterized by a spirit of complacency and disjointedness that creates



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