operations in such areas as research and polio eradication. Medicare paid providers almost $115 million in 1998, including $87 million for influenza immunizations, $27 million for pneumococcal immunizations, and $800,000 for hepatitis B immunizations (information provided by HCFA).

In addition to these federal investments, many states and some local governments contribute funds to the support of the national immunization system. The total cost of the state contribution to the purchase of vaccines and the operation of immunization programs, based on estimates provided by state immunization program managers, is estimated at $340 million for FY 2000 (information provided by CDC). This estimate includes funds provided by state and local governments, as well as other federal funds (e.g., Maternal and Child Health Title V grants) that support immunization efforts.

Limitations of Current Efforts

The current levels of public and private investment in immunization efforts have been successful in controlling infectious diseases and improving levels of immunization coverage. But persistent problems remain within the U.S. immunization system:

  • Mortality and morbidity from preventable infectious disease. Between 50,000 and 70,000 adults die annually in the United States from vaccine-preventable diseases (VPDs) or their complications, compared with approximately 300 U.S. children who die from VPDs each year (National Foundation for Infectious Disease, 1999).

  • Low coverage rates for adult vaccines. National levels for influenza coverage have increased from 58 percent (1995) to 63 percent (1997) for adults aged 65 and older, but the percentage immunized among adults aged 55 to 64 is still considerably lower, with a median of 38.2 percent nationwide (National Center for Health Statistics [NCHS], 1997). Pneumococcal coverage levels for persons 65 and older are also low—only 42 percent of noninstitutionalized adults aged 65 and over had ever received a pneumococcal vaccination by 1997 (NCHS, 1997). Coverage rates for high-risk adults (under age 65) are especially poor. Recent surveys indicate that 26 percent of this group received an influenza vaccination, while only 13 percent received a pneumococcal vaccination (NCHS, 1997).

  • Persistent disparities in levels of immunization coverage. Immunization coverage levels within areas of concentrated poverty or among mobile populations are significantly lower than national and statewide levels.5 National surveys reveal a gap of 9 percentage points between children above and below the federal poverty level for completion of the 4:3:1:3 vaccine series,6 which includes some of the most critical childhood vaccines

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