costs of supporting the infrastructure required to operate a national immunization program and respond to the needs of disadvantaged populations.

As discussed in an earlier section of this chapter, the committee believes the states bear responsibility for sharing the infrastructure costs of the national immunization system. About half of the states currently invest in immunization programs in addition to their vaccine purchases; the remaining half do not support infrastructure costs on a routine basis.

To reduce this disparity, the proposed formula for distributing federal funds should include a state match requirement—such as 75 federal/ 25 state—similar to that in place for other federal programs, such as Medicaid grants, Title V MCH grants, and block grants for the prevention and treatment of substance abuse. The details of the match requirement and the conditions under which it would operate should be developed through a series of dialogues with state and federal officials and public health leaders to ensure that the match is fair and equitable and that it does not disrupt ongoing immunization efforts.

Recommendation 5: CDC should initiate a dialogue with federal and state health agencies, state legislatures, state governors, and Congress immediately so that legislative and budgetary reforms can be proposed promptly when Section 317 is up for reauthorization in FY 2002.

The committee believes the grant formula should include weights that reflect factors of need, capacity, and performance. The calculation of these weights and the analytical process of constructing a formula must reflect special considerations that account for individual state needs and lie beyond the scope of this report. The calculations required include estimating the appropriate size of the federal base grant; determining appropriate “hold harmless” conditions; determining the nature of adequate state-level contributions; developing an appropriate set of proxy measures that reflect need, capacity, and performance in the field of immunization; and choosing the appropriate multiyear finance mechanism for the allocation of federal funds.

Recommendation 6: Federal and state agencies should develop a set of consistent and comparable immunization measures for use in monitoring the status of children and adults enrolled in private and public health plans.

Immunization coverage measures are important for identifying both community health needs and performance outcomes for selected service interventions. Measurement research can guide future federal and state

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