FIGURE ES-1 Six roles of the national immunization system.


Efforts to meet national immunization goals currently involve a set of intricate and separate financial arrangements among federal, state, and local health agencies, as well as collaborative ventures with public and private health care providers. In conducting the study, we gave particular attention to the responsibilities of federal, state, and local health agencies and the burden of effort that is required to support each of the above roles in an integrated manner. State governments are the public health stewards for disadvantaged populations within their borders, and have traditionally been responsible for meeting the health needs of residents who are not served or are underserved by the private health care sector. Each state currently invests in immunization programs through direct or in-kind support, but no state has sufficient resources to support all six of the above immunization roles. Consequently, federal assistance is required to help each state maintain the essential elements of an immunization pro-

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