porting immunization efforts. The lack of such a plan makes it difficult to establish program priorities or estimate the scale of investments necessary to sustain current levels of immunization coverage for children and adults. The absence of a national consensus about the roles and responsibilities of federal and state agencies in fostering immunization also complicates efforts to extend immunization benefits to the relatively small population of high-risk individuals who remain unprotected. Uncertainties about how the costs of such efforts should be allocated across the different levels of government lead to inefficiencies in the use of public resources, including redundant efforts, gaps in services, and unnecessary paperwork.

It is for these reasons that the U.S. Senate Appropriations Committee in 1998 asked IOM to conduct a study of the Section 317 program.7 The study was designed to identify areas in which research-based evidence can guide federal, state, and local immunization policies and practices. The Congress formulated five key questions as the basis for the IOM study:

  1. What was the extent of overall spending by all sources for immunizations in the United States during the 1990s?

  2. How were new federal funds spent by the states, and to what extent did states maintain their own levels of effort over the past 5 years?

  3. What are current and future funding requirements for immunization activities, and how can those requirements be met through a combination of state funding, federal Section 317 immunization grant funding, and funding available through SCHIP?

  4. How should federal grant funds be distributed among the states?

  5. How should funds be targeted within states to reach high-risk populations without diminishing levels of coverage among the overall population?

In addition, a sixth question was posed by CDC during the negotiation of the study contract:

  1. What should be the role and financing level for CDC’s current program supporting state efforts to vaccinate adults and achieve the nation’s goals for influenza and pneumococcal vaccines?

These questions reflect a need for guidance regarding the level of national effort necessary to achieve immunization objectives, as well as strategies that can balance federal and state contributions in extending the benefits of immunization to unprotected children and adults.

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