preventable illness and subsequent complications that result from missed vaccines carry a high and avoidable cost for individuals and society as a whole.

  • Serious gaps and inconsistencies in the coordination, support, and documentation of immunization efforts. Stress-related cracks stemming from the complexity of the nation’s immunization system show signs of deepening as shifts occur within public and private health care delivery systems. Recent controversies over the use of federally financed vaccines for children who are enrolled in stand-alone (i.e., non-Medicaid) state-sponsored insurance programs, for example, reflect inconsistencies and ambiguities in service-delivery efforts.

The collective result of the above trends is diminishing the public benefit of vaccines, especially for groups of children and adults who do not have routine access to high-quality primary care.


Current analyses of federal and state spending for immunization services and programs reveal the absence of a strategic plan that can guide a federal-state partnership in supporting immunization efforts. The absence of a national consensus about the roles and responsibilities of federal and state agencies in fostering immunization also complicates efforts to extend the benefits of immunization to the relatively small population of high-risk children and the larger pool of adults who remain unprotected.

It is for these reasons that the U.S. Senate Appropriations Committee in 1998 asked the Institute of Medicine (IOM) to conduct a study of the Section 317 program administered by the Centers for Disease Control and Prevention (CDC).1 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 the State Children’s Health Insurance Program (SCHIP)?

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

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