FY 2000) is sufficient to meet state requests for child vaccines within the immunization schedule recommended by ACIP as of January 2000.6 But additions to the ACIP schedule will expand the burden of preventive health care costs to state and federal health agencies as well as private health plans. Such additional costs should be expected as part of the changing immunization system. Congress should anticipate such cost increases by requiring that CDC notify Congress each year of two trends: (1) the estimated cost impact of new vaccines (including administration fees) that are scheduled for consideration as additions to the recommended immunization schedule, and (2) the length of time that may be involved from the point at which such vaccines are recommended by ACIP to the establishment of a VFC contract. Federal and state vaccine purchase budgets should then be adjusted as necessary.

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.

These estimates are based on calculations of the residual vaccine needs for uninsured and underinsured at-risk populations, including adults who are younger than age 65 and suffer from chronic disease (see Box 3–3 in Chapter 3); for hepatitis B coverage among adolescents; for adults who are at risk because of sexual behavior or occupational settings; and for tetanus coverage. Both federal and state vaccine purchase budgets will require annual adjustments as vaccine costs change or new vaccines or age groups are added to the adult immunization schedule. Therefore, CDC notification of the impact of such changes should be required annually, as indicated in Recommendation 1.

The improvement of adult immunization rates will require more than increased vaccine purchases. A comprehensive and coordinated adult immunization program needs to be initiated within each state, with leadership at the national, state, and local levels, to encourage the participation of private and public health care providers in offering immunizations to adults under the guidelines established in the ACIP schedule.

Recommendation 3: State immunization infrastructure programs require increased financial and administrative support

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