grants that provide funds for both direct services and other components of the state’s immunization program; and (3) federal personnel and technical expertise, especially in such areas as information collection, data analysis, and long-term planning. Section 317, established in 1963, was the first in a series of late 20th-century federal initiatives related to immunizations and primary health care services for disadvantaged families.

Creation of the VFC Program

In 1994, the VFC program was launched as a new entitlement for Medicaid and uninsured children and other groups specified by law. Section 13631 of the Omnibus Budget Reconciliation Act of 1993 created VFC as a means of providing free vaccine to children aged 18 and younger who are uninsured, are eligible for Medicaid, or are Alaska Natives or American Indians. Underinsured children (those whose insurance does not cover childhood vaccinations) are also eligible for VFC vaccines, but may receive them only in federally qualified health centers or rural health clinics (see Chapter 3 for further discussion of the program).

VFC is a vaccine purchase program designed to encourage the provision of immunizations to children within a “medical home” that provides basic primary care services. VFC was created on the premise that the cost of vaccine for parents constituted a major barrier to children’s timely immunization, an assumption that was not supported in an evaluation study prepared by the General Accounting Office (GAO) in 1995. GAO concluded that strategies other than VFC may better improve timely vaccination among children, potentially at lower public cost, by reducing missed opportunities for immunization through Medicaid, public health clinics, and other providers with whom underimmunized children already have contact (GAO, 1995a:3). Furthermore, GAO observed that CDC cannot ensure that VFC will reach pockets of need—areas or populations in which immunization rates are low and the risk of disease is consequently high. The legislation creating the VFC program limits VFC expenditures to vaccine purchase and narrowly defined operational costs, such as expenses associated with ordering, inventory maintenance, vaccine distribution, and provider enrollment. VFC lacks any built-in evaluation mechanism that could measure its performance in providing vaccine to at-risk children or attribute changes in age-appropriate immunization rates to the program’s operation.

Despite these limitations, VFC has been successful in attracting the participation of public and private health care providers. In 1998, an estimated 44,000 public and private providers were eligible to receive VFC vaccines.

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