NATIONAL ACADEMY PRESS
2101 Constitution Avenue, N.W.Washington, D.C. 20418
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.
Funding for this project was provided by the Carnegie Corporation of New York under grant D 93031 and the National Immunization Program of the Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, under grant R13/CCR310159-01. The views presented are those of the Institute of Medicine Committee on Overcoming Barriers to Immunization and the participants in the workshop and are not necessarily those of the funding organizations.
Additional copies of this report are available from:
Division of Health Promotion and Disease Prevention
Institute of Medicine
2101 Constitution Avenue, N.W.
Washington, DC 20418
Copyright 1994 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemusseen in Berlin.
COMMITTEE ON OVERCOMING BARRIERS TO IMMUNIZATION
LORRAINE V. KLERMAN( Chair),
Professor and Chairperson,
Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
PHYLLIS FREEMAN, Associate Professor,
Law Center,
andSenior Fellow,
John W. McCormack Institute of Public Affairs, University of Massachusetts, Boston, Massachusetts
FERNANDO A. GUERRA, Director of Health,
San Antonio Metropolitan Health District, San Antonio, Texas
KAY A. JOHNSON, Director,
Policy and Government Affairs, March of Dimes Birth Defects Foundation, Washington, D.C.
EDGAR K. MARCUSE, Director,
Ambulatory Care Services, Children's Hospital and Medical Center, Seattle, Washington
PATRICIA DOLAN MULLEN, Professor
andDeputy Director,
Center for Health Promotion Research and Development, The University of Texas Health Science Center/Houston, Houston, Texas
ROBERT K. ROSS, Director,
Department of Health Services, County of San Diego, San Diego, California
HENRY R. SHINEFIELD, * Emeritus Chief of Pediatrics
andCo-Director,
Vaccine Study Center, The Permanente Medical Group, San Francisco, California
Institute of Medicine Staff
JANE S. DURCH, Study Director
SARAH S. BROWN, Senior Program Officer
LINDA A. DePUGH, Administrative Assistant
MICHAEL A. STOTO, Director,
Division of Health Promotion and Disease Prevention
*Institute of Medicine member. |
WORKSHOP SPEAKERS
ROGER BERNIER, Centers for Disease Control and Prevention, Atlanta, Georgia
STEVEN BLACK, Northern California Kaiser Permanente, Oakland, California
EUGENE DINI, Centers for Disease Control and Prevention, Atlanta, Georgia
JAMES FEIST, Private Practice (Pediatrics), Bozeman, Montana
JEFFREY GOLDHAGGEN, Duval County Public Health Department, Jacksonville, Florida
RITA GOODMAN, Health Resources and Services Administration, Rockville, Maryland
ELIZABETH HOLT, The Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland
CHRISTOPHER KOEPKE, Albert Einstein Medical Center, Philadelphia, Pennsylvania
ALAN KOHRT, Private Practice (Pediatrics), Honesdale, Pennsylvania
SUSAN LETT, Massachusetts Department of Public Health, Boston, Massachusetts
TRACY LIEU, Northern California Kaiser Permanente, Oakland, California
HERMINIA LUNA, Chicago Department of Health, Chicago, Illinois
ROSE ANN MEINECKE, Maryland Department of Health and Mental Hygiene, Baltimore, Maryland
WALTER ORENSTEIN, Centers for Disease Control and Prevention, Atlanta, Georgia
CARMEN PARIS, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
MAGDA PECK, CityMatCH, Omaha, Nebraska
ANTHONY ROBBINS, National Vaccine Program Office, Washington, D.C.
LANCE RODEWALD, University of Rochester School of Medicine and Dentistry, Rochester, New York
IRWIN ROSENSTOCK, University of Michigan (emeritus), Sarasota, Florida
DAVID SALISBURY, Department of Health, London, United Kingdom
DAVID SIEGEL, Health Alliance Plan of Michigan, Detroit, Michigan
DAVID SMITH, Texas Department of Health, Austin, Texas
PETER SZILAGYI, University of Rochester School of Medicine and Dentistry, Rochester, New York
THOMAS VERNON, Merck & Company, Inc., West Point, Pennsylvania
DAVID WOOD, UCLA School of Medicine, Los Angeles, California
PARTICIPANTS
BARBARA ALIZA, Association of Maternal and Child Health Programs, Washington, D.C.
LUCY ANDRIS, Healthy Mothers, Healthy Babies Coalition, Washington, D.C.
ALLAN ARBETER, Albert Einstein Medical Center, Philadelphia, Pennsylvania
NORMA DAVIES BALL, Special Nutrition Program, U.S. Department of Agriculture, Washington, D.C.
PETER BOUXSEIN, National Vaccine Program Office, Washington, D.C.
JOEL BREMAN, National Vaccine Program Office, Washington, D.C.
EDWARD BRINK, Centers for Disease Control and Prevention, Atlanta, Georgia
ROBERT COSBY, Metropolitan Washington Council of Governments, Washington, D.C.
CIRO A. DE QUADROS, Pan American Health Organization, Washington, D.C.
AMY FINE, Association of Maternal and Child Health Programs, Washington, D.C.
JUANITA FLEMING, University of Kentucky, Lexington, Kentucky
PAULA FRANKLIN, Children's Defense Fund, Washington, D.C.
ELIZABETH GOSS, Fox, Bennett & Turner Law Firm, Washington, D.C.
BURTON HALPERT, Cooperative Extension Service, U.S. Department of Agriculture, Washington, D.C.
JAMES HANSON, National Vaccine Program Office, Washington, D.C.
CYNTHIA HOWE, Institute of Medicine, Washington, D.C.
NANCY HUGHART, The Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland
RUTH KATZ, Committee on Energy and Commerce, U.S. House of Representatives, Washington, D.C.
LAURA KAVANAGH, National Center for Education in Maternal and Child Health, Arlington, Virginia
NANCY KELLEY, Office of Senator Dale Bumpers, Washington, D.C.
MARY RUPP KOPP, Kansas State Nurses Association, Topeka, Kansas
HOWARD W. KROLL, Health Resources and Services Administration, Rockville, Maryland
CAROL LOGAN KUHNS, National Center for Education in Maternal and Child Health, Arlington, Virginia
SHEREE CHIN LEDWELL, Group Health Association of America, Washington, D.C.
ADORA LEE, Academy for Educational Development, Washington, D.C.
JODIE LEVIN-EPSTEIN, Center for Law and Social Policy, Washington, D.C.
MARY McCALL, Association of State and Territorial Health Officials, Washington, D.C.
LAURIE MICHEL, Connaught Laboratories, Inc., Washington, D.C.
PAMELA MITTELSTADT, Group Health Association of America, Washington, D.C.
LYN MORTIMER, Carnegie Corporation of New York, Washington, D.C.
ELENA NIGHTINGALE, Carnegie Corporation of New York, Washington, D.C.
AUDREY NORA, Health Resources and Services Administration, Rockville, Maryland
DENNIS O'MARA, Centers for Disease Control and Prevention, Atlanta, Georgia
JEANNE PRIESTER, Cooperative Extension Service, U.S. Department of Agriculture, Washington, D.C.
REGINA RABINOVICH, National Vaccine Program Office, Washington, D.C.
H. R. SHEPHERD, Armstrong Pharmaceuticals, Inc., New Canaan, Connecticut
WILLA SIEGEL, Administration for Children and Families, U.S. Department of Health and Human Services, Washington, D.C.
KIMBERLY SPAULDING, Labor and Human Resources Committee, U.S. Senate, Washington, D.C.
PAUL STEHR-GREEN, Centers for Disease Control and Prevention, Atlanta, Georgia
DAVID STEVENS, Health Resources and Services Administration, Rockville, Maryland
RON TESKE, Centers for Disease Control and Prevention, Atlanta, Georgia
WILLIAM WATSON, JR., Task Force for Child Survival, Atlanta, Georgia
ELIZABETH WEHR, Center for Health Policy Research, Washington, D.C.
RICHARD ZIMMERMAN, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Acknowledgments
The workshop steering committee and staff would like to acknowledge assistance from several individuals and organizations. The Institute of Medicine (IOM) obtained initial funding for this project from the Carnegie Corporation of New York. Additional funds were provided by the National Immunization Program (NIP) at the Centers for Disease Control and Prevention. Many members of the NIP staff provided assistance. Walter Orenstein, NIP Director, and Paul Stehr-Green, project officer for the workshop, were particularly helpful. The project also benefited from funds made available through the IOM's Board on Health Promotion and Disease Prevention. The National Vaccine Program Office played an important role in encouraging IOM to undertake this project; Anthony Robbins and James Hanson, in particular, provided valuable guidance. Critical to the success of the workshop was the active and thoughtful participation of 26 speakers and some 40 other attendees, who are listed in the rosters at the beginning of the report. Other individuals who did not attend the workshop also provided assistance: Roger Barkin, Rose Medical Center, Denver; Virginia Burggraf, American Nurses Association; Linda Talbot, Every Child By Two; and Herbert Young, American Academy of Family Physicians.
The workshop was conducted in cooperation with the Board on Children and Families (Deborah Phillips, Director), which operates through both the National Research Council and the IOM. Reviewers from the Board on Health Promotion and Disease Prevention and the Board on Children and Families contributed constructive comments. Michael Hayes provided helpful editorial assistance. Several IOM staff members made valuable contributions to planning and
conducting the workshop and preparing the report: Sarah Brown, Claudia Carl, Michael Edington, Judith Doody, Polly Harrison, Cynthia Howe, Carrie Ingalls, Dorothy Majewski, Violaine Mitchell, and Gail Spears. Linda DePugh provided essential administrative and logistical support throughout the project. Michael Stoto, Director of the Division of Health Promotion and Disease Prevention, guided the project from its inception.
Acronyms
AAP
American Academy of Pediatrics
ACIP
Advisory Committee on Immunization Practices
AFDC
Aid to Families with Dependent Children
ATPM
Association of Teachers of Preventive Medicine
CDC
Centers for Disease Control and Prevention
DHHS
Department of Health and Human Services
GHAA
Group Health Association of America
HMO
Health maintenance organization
HRSA
Health Resources and Services Administration
IAP
Immunization Action Plan
IOM
Institute of Medine
NHIS
National Health Interview Survey
NIP
National Immunization Program
NVAC
National Vaccine Advisory Committee
NVPO
National Vaccine Program Office
VIP
Vaccine Information Pamphlet
WIC
Special Supplemental Food Program for Women, Infants, and Children
VACCINES
DTP
Diphtheria-tetanus-pertussis vaccine
DTaP
Diphtheria-tetanus-acellular pertussis vaccine
Hib
Haemophilus influenzae type b vaccine
MMR
Measles-mumps-rubella vaccine
OPV
Oral poliovirus vaccine