nantly unvaccinated preschool racial and ethnic minority children in inner cities” (U.S. Senate, 1991). Other witnesses expressed the view that low-income working families living in communities across the country faced financial barriers to immunization.

A year later President Bush announced the Infant Immunization Initiative, targeted at improving the low immunization rates of certain populations, including those under age 2. The model immunization plans were the beginning of a national effort to ensure adequate and timely immunization of infants and young children. This ultimately resulted in the preparation of Immunization Action Plans (Orenstein et al., forthcoming). The Childhood Immunization Initiative, a major effort launched in the early years of the Clinton Administration, subsequently strengthened this effort to include the creation of the Vaccines for Children program and the expansion of the Section 317 program in the early 1990s.

serve as hosts for preventable pathogens such as pertussis. The continued presence of large groups of children and adults that do not have regular access to immunization services also represents an important indicator for those monitoring the performance of the U.S. health care system in meeting the basic health care needs of an increasingly diverse population.

It is ironic that the United States is now in the situation of creating an impressive array of vaccines that can reduce and perhaps eliminate the dreaded diseases that threatened prior generations of Americans, while at the same time relying on a patchwork system for purchasing, distributing, and administering these powerful drugs that undermines the effectiveness of the nation’s disease prevention strategy. It is time, therefore, for a strategic vision that can clarify the roles and responsibilities of state and federal agencies in achieving national immunization goals and provide the resources to support this effort.

Role of the Section 317 Program

In the first few decades of the formation of the national immunization partnership, the federal role was limited primarily to the purchase of vaccines that would allow the states to meet the needs of disadvantaged children (see Appendix B for a chronology of the U.S. immunization system). Over time, the federal role gradually expanded to include three key features: (1) financial assistance that allows the states to purchase vaccines collectively under a federal contract at discount prices; (2) infrastructure

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