Appendix B

Immunization Time-Line

1955

Poliomyelitis Vaccination Assistance Act (President Eisenhower)

• Start of federal funding for immunization (primarily vaccine purchase)
• Public Health Service begins to collect data on national immunization rates (polio)

1962–1964		Vaccination Assistance Act (President Kennedy)

• Adoption of Section 317 of the Public Health Service Act and creation of the National Immunization Program at CDC (1963)
• Federal funds targeted for vaccine purchase for polio, diphtheria, pertussis, and tetanus (measles added to federal purchase plan in 1965)
• 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)
• Major outbreak of rubella affecting pregnant women (1964--no vaccine available)

1966–1968		Partnership for Health Initiative (President Johnson)

• Part of broader effort to reduce growing number of federal categorical programs in health
• Section 317 program replaced with state block grants
• Disease reports decline in four key categories (measles, polio, pertussis, and diphtheria)
• Federal resources shifted away from state grants and measles vaccine to support purchase of rubella vaccine when license was approved (1969)
• Compulsory school laws adopted by half of the states

1970		New Section 317 authority restored (President Nixon)

• Reported measles cases increased sharply (1969–1971)
• Reports of insufficient state funds, personnel, and activity in immunization programs other than rubella
• Earlier block grant effort seen as weakening of federal effort, leading to disease outbreaks

1976–1978		National Childhood Immunization Initiative (President Carter)

• Second measles outbreak in 1977
• New initiative stimulated by Mrs. Betty Bumpers, wife of Arkansas Governor Dale Bumpers
• Federal commitment made to increase and maintain immunization levels among school-aged children to 90% and above (coverage rates reported as 95%)
• 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)

• Level of federal support remained stable but did not grow
• New vaccines added to immunization schedule
• Public health delivery system remained unchanged
• National Childhood Vaccine Injury Act (1986) adopted

1991		Federal Request for State Immunization Action Plans (President Bush)

• Measles epidemic in 1989–1991
• Announced federal goal of raising national immunization levels among preschool children to 90% by year 2000
• Immunization Action Plans formulated by all states and 28 metropolitan areas
• 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)

• 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)
• 90% coverage rate for most vaccines for preschool children achieved by 1996
• 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)

• 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)
• Childhood immunization coverage rates reached record highs
• Influenza coverage for adults reached new high rates
• State immunization grants within Section 317 budget decreased significantly
• States reported cutbacks in vaccine administration services, outreach programs, and data collection efforts

SOURCE: Adapted from Vivier, 1996.