Calling the Shots: Immunization Finance Policies and Practices

tively low vaccine utilization. Because of the association of appropriate health care with an individual’s economic status, race, and gender, access to immunization coverage proves difficult for many racial and ethnic minorities. For example, although rubella has been virtually eliminated within the U.S.-born population, rubella outbreaks have occurred sporadically among Hispanic populations in the last 5 years as a result of immigration from countries where rubella vaccine is not part of the childhood immunization schedule (information provided by CDC).

Finding 2–4. Important strides have been made in decreasing the incidence of vaccine-preventable diseases and increasing the immunization coverage levels for children and adults. However, sustained efforts are needed to address the troublesome disparities that remain in childhood and adult coverage levels.

ENDNOTES

1.	The harmonized schedule is determined jointly by the American Academy of Pediatrics (AAP), the Advisory Committee on Immunization Practices (ACIP), and the American Academy of Family Physicians (AAFP).
2.	For example, researchers are experimenting with a measles, mumps, rubella, varicella (MMRV) vaccine that will include four distinct antigens in one injection (S.Katz, Duke University, personal communication, 1999).
3.	“Other” includes community health centers, the military, hospital-based clinics, and those who describe themselves as “other.”

Table of Contents

Front Matter R1-R20

Executive Summary 1-17

Introduction 18-53

Change and Complexity in the National Immunization System 54-70

Financing Vaccine Purchase and Delivery 71-102

Building, Monitoring, and Sustaining Immunization Capacity 103-141

Immunization Finance Policies and Practices 142-192

Summary Findings, Conclusions, and Recommendations 193-227

References 228-242

Appendix A: Public Health Services Act, Section 317 243-249

Appendix B: Immunization Time-Line 250-252

Appendix C: List of Contributors 253-260

Appendix D: Overview of State Survey 261-262

Appendix E: Overview of Case Studies and Site Visits 263-270

Appendix F: Annual Section 317 Awards to States 271-281

Appendix G: State Immunization Requirements for School Children 282-286

Appendix H: Committee and Staff Biographies 287-294

Index 295-308

ENDNOTES