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Calling the Shots: Immunization Finance Policies and Practices Appendix B Immunization Time-Line 1955 Poliomyelitis Vaccination Assistance Act (President Eisenhower) Start of federal funding for immunization (primarily vaccine purchase) Public Health Service begins to collect data on national immunization rates (polio) 1962–1964 Vaccination Assistance Act (President Kennedy) Adoption of Section 317 of the Public Health Service Act and creation of the National Immunization Program at CDC (1963) Federal funds targeted for vaccine purchase for polio, diphtheria, pertussis, and tetanus (measles added to federal purchase plan in 1965) National data collection efforts expanded to include vaccine coverage rates for diphtheria, pertussis, tetanus, and measles (rates increased from 68% in 1962 to mid to high 70% range by the end of the decade) Major outbreak of rubella affecting pregnant women (1964—no vaccine available)
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Calling the Shots: Immunization Finance Policies and Practices 1966–1968 Partnership for Health Initiative (President Johnson) Part of broader effort to reduce growing number of federal categorical programs in health Section 317 program replaced with state block grants Disease reports decline in four key categories (measles, polio, pertussis, and diphtheria) Federal resources shifted away from state grants and measles vaccine to support purchase of rubella vaccine when license was approved (1969) Compulsory school laws adopted by half of the states 1970 New Section 317 authority restored (President Nixon) Reported measles cases increased sharply (1969–1971) Reports of insufficient state funds, personnel, and activity in immunization programs other than rubella Earlier block grant effort seen as weakening of federal effort, leading to disease outbreaks 1976–1978 National Childhood Immunization Initiative (President Carter) Second measles outbreak in 1977 New initiative stimulated by Mrs. Betty Bumpers, wife of Arkansas Governor Dale Bumpers Federal commitment made to increase and maintain immunization levels among school-aged children to 90% and above (coverage rates reported as 95%) Growth occurred in federal grants for state immunization budgets ($5 million in 1976 to $35 million in 1979) 1986–1988 Continued Federal Support for State and Local Grantees (President Reagan) Level of federal support remained stable but did not grow New vaccines added to immunization schedule Public health delivery system remained unchanged National Childhood Vaccine Injury Act (1986) adopted
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Calling the Shots: Immunization Finance Policies and Practices 1991 Federal Request for State Immunization Action Plans (President Bush) Measles epidemic in 1989–1991 Announced federal goal of raising national immunization levels among preschool children to 90% by year 2000 Immunization Action Plans formulated by all states and 28 metropolitan areas Federal grant funds authorized for direct delivery of immunization services as well as vaccine purchase (new awards for state grants tripled from $37.0 million in 1991 to $98.2 million in 1993) 1993–1995 Childhood Immunization Initiative (President Clinton) Major infusion of federal funds for service delivery and immunization programs, including surveillance, assessment, and registry activities (peak of $261 million in state and local awards in 1995) 90% coverage rate for most vaccines for preschool children achieved by 1996 Vaccines for Children Program adopted as amendment to Medicaid (1994), providing >$500 million in federal funds for vaccine purchase and delivery 1996–1998 New Federal-State Partnerships in Health Care Services (President Clinton) State Children’s Health Insurance Program (1997) adopted as a major new block grant program for the states to ensure access to health care services, including immunization services for uninsured children (<18 years) Childhood immunization coverage rates reached record highs Influenza coverage for adults reached new high rates State immunization grants within Section 317 budget decreased significantly States reported cutbacks in vaccine administration services, outreach programs, and data collection efforts SOURCE: Adapted from Vivier, 1996.
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