Five chapters follow this introduction. Chapter 2 explains how today’s U.S. immunization system differs from that of 1990 and earlier decades, and identifies emerging challenges and scientific opportunities in the decades ahead that have finance implications for the national immunization system. Chapters 3, 4, and 5 address the six roles of the national immunization system: vaccine purchase and service delivery (Chapter 3); infectious disease prevention and control, surveillance of vaccine coverage and safety, and efforts to improve and sustain coverage rates (Chapter 4); and immunization finance policies and practices (Chapter 5). Throughout Chapters 2 through 5, the committee’s findings are in italics. In Chapter 6, the committee uses these findings to respond to the six questions posed under our charge and to formulate a final set of conclusions and recommendations.



Local health agencies play important public health roles, but they are usually not involved in financing vaccine purchase or immunization infrastructure efforts. The analyses in this study also do not include current or former U.S. territories (American Samoa, Guam, Republic of the Marshall Islands, Federated States of Micronesia, the North Mariana Islands, Republic of Belau, Puerto Rico, and the Virgin Islands), even though they are grantees within the National Immunization Program. The analyses are confined to state-level efforts because the committee’s charge focused explicitly on state budgetary roles.


Costs are not adjusted for inflation.


The six municipalities are Chicago, Illinois; New York City, New York; Philadelphia, Pennsylvania; Houston and San Antonio, Texas; and the District of Columbia.


These jurisdictions are American Samoa, Guam, the Marshall Islands, Micronesia, the North Mariana Islands, Belau, Puerto Rico, and the Virgin Islands.


The term mobile populations refers to a variety of groups that have no fixed residence or frequently change residences within a limited period of time. They include immigrants (both legal and illegal), migrant workers, and the homeless.


The 4:3:1:3 series includes four doses of DTaP; three doses of polio; one dose of measles, mumps, and rubella (MMR); and three doses of Haemophilus influenzae type b (Hib). The coverage status of 2-year-olds is measured between 18 and 35 months of age.


The IOM study was requested in U.S. Senate Report 105–300 to accompany S. 2440 (Departments of Labor, Health and Human Services, and Education and Related Agencies Appropriations Bill), which directed CDC to contract with IOM to conduct an evaluation of the recent successes, resource needs, cost structure, and strategies for immunization efforts in the United States.


NVAC (1999a:364), citing research from the Employee Benefit Research Institute (Fronstin, 1996), observes that 54 percent of infants and 62 percent of children aged 1 through 5 are covered by private health insurance.


See the ACIP recommendation for pneumococcal vaccine (CDC, 2000d).


Other IOM committees have addressed some of these issues. See, for example, Vaccines for the 21st Century (IOM, 1999b).

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