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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