FIGURE 1–3 Amount of total annual awardsa of Section 317 Funds, Direct Assistance (DA)b and Financial Assistance (FA),c 1990–1999. aTotal funds include new funds plus carryover. bDA funds include funds for vaccine purchase and operations. cFA funds include funds for state infrastructure programs. SOURCE: Information provided by CDC.

to include year-round clinic services, outreach, education, and data collection responsibilities, costs were shared between the states and the federal government. Investments were often financed through emergency appropriation bills or vaccine purchase budgets that drew strong bipartisan support in the interest of controlling outbreaks of infectious disease.

Public health clinics have traditionally provided free vaccines for disadvantaged families and are commonly the first line of defense during outbreaks or epidemics. Special community-based immunization programs such as “Back to School Shots” still continue in many disadvantaged neighborhoods. Today, however, immunizations are routinely acquired within the set of clinical services associated with primary preventive care and well-baby health care. Third-party coverage of immunization services, financed through private and public insurance plans, is more common, resulting in declining use of public health clinics to deliver immuni-

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