1. How should funds be targeted within states to reach high-risk populations without diminishing levels of coverage among the overall population?

In addition, a sixth question was added by CDC during the negotiation of the study contract:

  1. What should be the role and financing level for CDC’s current program supporting state efforts to vaccinate adults and achieve the nation’s goals for influenza and pneumococcal vaccines?

These questions reflect a need for guidance to clarify roles and help balance federal and state contributions in extending the benefits of immunization to unprotected children and adults.


In examining current immunization policies and practices in the public and private health care sectors, the IOM committee identified six fundamental roles of the national immunization system:

  • Assure the purchase of recommended vaccines for the total population of U.S. children and adults, with particular emphasis on the protection of vulnerable groups.

  • Assure access to such vaccines within the public sector when private health care services are not adequate to meet local needs.

  • Control and prevent infectious disease.

  • Conduct population wide surveillance of immunization coverage levels, including the identification of significant disparities, gaps, and vaccine safety concerns.

  • Sustain and improve immunization coverage levels within child and adult populations, especially in vulnerable communities.

  • Use primary care and public health resources efficiently in achieving national immunization goals.

The last of these roles provides overarching support for the other five, and was the focus of the committee’s charge. Figure ES-1 displays these roles as components of the national immunization partnership.

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