Appendix B
Immunization Time-Line
1955 Poliomyelitis Vaccination Assistance Act (President Eisenhower)
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Start of federal funding for immunization (primarily vaccine purchase)
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Public Health Service begins to collect data on national immunization rates (polio)
1962–1964 Vaccination Assistance Act (President Kennedy)
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Adoption of Section 317 of the Public Health Service Act and creation of the National Immunization Program at CDC (1963)
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Federal funds targeted for vaccine purchase for polio, diphtheria, pertussis, and tetanus (measles added to federal purchase plan in 1965)
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National data collection efforts expanded to include vaccine coverage rates for diphtheria, pertussis, tetanus, and measles (rates increased from 68% in 1962 to mid to high 70% range by the end of the decade)
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Major outbreak of rubella affecting pregnant women (1964—no vaccine available)
1966–1968 Partnership for Health Initiative (President Johnson)
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Part of broader effort to reduce growing number of federal categorical programs in health
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Section 317 program replaced with state block grants
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Disease reports decline in four key categories (measles, polio, pertussis, and diphtheria)
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Federal resources shifted away from state grants and measles vaccine to support purchase of rubella vaccine when license was approved (1969)
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Compulsory school laws adopted by half of the states
1970 New Section 317 authority restored (President Nixon)
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Reported measles cases increased sharply (1969–1971)
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Reports of insufficient state funds, personnel, and activity in immunization programs other than rubella
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Earlier block grant effort seen as weakening of federal effort, leading to disease outbreaks
1976–1978 National Childhood Immunization Initiative (President Carter)
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Second measles outbreak in 1977
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New initiative stimulated by Mrs. Betty Bumpers, wife of Arkansas Governor Dale Bumpers
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Federal commitment made to increase and maintain immunization levels among school-aged children to 90% and above (coverage rates reported as 95%)
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Growth occurred in federal grants for state immunization budgets ($5 million in 1976 to $35 million in 1979)
1986–1988 Continued Federal Support for State and Local Grantees (President Reagan)
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Level of federal support remained stable but did not grow
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New vaccines added to immunization schedule
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Public health delivery system remained unchanged
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National Childhood Vaccine Injury Act (1986) adopted
1991 Federal Request for State Immunization Action Plans (President Bush)
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Measles epidemic in 1989–1991
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Announced federal goal of raising national immunization levels among preschool children to 90% by year 2000
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Immunization Action Plans formulated by all states and 28 metropolitan areas
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Federal grant funds authorized for direct delivery of immunization services as well as vaccine purchase (new awards for state grants tripled from $37.0 million in 1991 to $98.2 million in 1993)
1993–1995 Childhood Immunization Initiative (President Clinton)
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Major infusion of federal funds for service delivery and immunization programs, including surveillance, assessment, and registry activities (peak of $261 million in state and local awards in 1995)
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90% coverage rate for most vaccines for preschool children achieved by 1996
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Vaccines for Children Program adopted as amendment to Medicaid (1994), providing >$500 million in federal funds for vaccine purchase and delivery
1996–1998 New Federal-State Partnerships in Health Care Services (President Clinton)
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State Children’s Health Insurance Program (1997) adopted as a major new block grant program for the states to ensure access to health care services, including immunization services for uninsured children (<18 years)
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Childhood immunization coverage rates reached record highs
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Influenza coverage for adults reached new high rates
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State immunization grants within Section 317 budget decreased significantly
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States reported cutbacks in vaccine administration services, outreach programs, and data collection efforts
SOURCE: Adapted from Vivier, 1996.
