finance immunizations for the remaining half of the children dependent on public-sector services, roughly 12 to 15 percent of their annual birth cohort.

The programmatic objectives of the National Immunization Program administered by CDC are described as follows:

A goal of the Immunization Grant Program has always been to help ensure that the Nation’s citizens have access to and receive all appropriate, routinely recommended vaccines. Throughout the existence of the Program, vaccines for use in the public sector have been purchased with a combination of Federal, State and local funds…. overall, the 317 program purchased 50–60 percent of vaccines used in the public sector [prior to VFC]. However, CDC never intentionally established a “goal” of purchasing 50–60 percent of the public sector need. This proportion was arrived at through a combination of circumstances, including what States were able to contribute, which vaccines the 317 funds were buying (usually the higher-priced and newer products), and available appropriations (information provided by CDC).

In the early years of the program, Section 317 grants for vaccine purchase (DA) and program administration (FA) were roughly equivalent. Over time, however, as vaccine costs rose and the schedule of recommended vaccines increased, vaccine purchase accounted for a higher proportion of total funds received (Kelley et al., 1993). This balance within the Section 317 program shifted once again after the VFC program became operational in October 1994 and relieved many of the demands on states’ 317 DA grants for pediatric vaccines (see Figures 1–3, 3–3, 3–4, and Appendix F).

Since 1994, at the direction of the Senate Appropriations Committee, CDC has reserved $33 million in FA funds each year for incentive awards to grantees with the highest immunization coverage rates, as measured by the National Immunization Survey (NIS) for 2-year-olds who are up to date with the 4:3:1 immunization series (four DTP, three polio, and one measles). Variable bonuses are available on a per child basis, according to the grantee’s completion rate. As the FA grants have declined over the past 5 years, these incentive funds have become an increasingly larger proportion of overall infrastructure funding, representing 28 percent of new FA funds awarded in 1998.

Finding 3–4. The Section 317 vaccine purchase program allows states to purchase vaccines for administration to disadvantaged populations in a timely manner and to avoid missed opportunities when no other coverage is available to support immunization services. Section 317 infrastructure grants also provide funds for service delivery in the public health sector, and afford state immunization programs swift access to



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