Index

A

Adult vaccination, 177

coverage levels, 4, 29, 69, 87, 217–220

current schedule, 21, 55

disparities in coverage, 4, 69–70, 218

federal government, 205, 219

high-risk populations, 4, 29, 87, 205, 218–219

immunization program needs, 2, 15, 195, 205, 219–220, 224

insurance coverage, 72, 77, 87, 89, 144–145, 219

Medicaid coverage, 83–84, 87–89

Medicare coverage, 86

Medicare spending, 8, 94–196

Section 317 program for, 90, 219

Adverse reactions, 60

Advisory Committee on Immunization Practices (ACIP), 14, 15, 21, 23, 55, 57, 64, 71, 74, 77, 78, 106, 125, 157, 205, 224

implementation of recommendations, 78–79, 98–99, 201

recommendations for adult vaccination, 89

Aid to Families with Dependent Children, 35

Alabama, 50, 201

Alaska, 37, 78, 106, 218

American Academy of Family Physicians, 23, 57

American Academy of Pediatrics, 23, 24, 51, 55, 57, 74, 125

American Association of Health Plans, 51

American Medical Association, 57

American Samoa, 27

Antibiotic resistance, 59

Arizona, 218

Arkansas, 67

Assessment, assurance, and policy development

government role, 11, 103

national immunization strategy, 2, 39–43

private-sector role, 104

See also Infrastructure, public health

Assessment and feedback intervention, 42, 134–135, 139, 179

Association of Maternal and Child Health Programs, 51

Association of State and Territorial Health Officers, 51

Autism, 125–126

B

Belau, 27

Birth rate, 4, 19

Bush administration, 35–36

C

California, 83, 115, 147, 201

See also Los Angeles, San Diego

Capitated payments, 62, 63, 67, 83, 85, 147

Carryover of funds, 51, 180–183, 191 n.6, 192 n.14, 203

Carter administration, 35

Case studies, 51, 263–270

See also specific site

Centers for Disease Control and Prevention, 2, 5, 8, 26, 64, 79, 113, 119, 125, 168, 175

adult vaccination role, 6, 33, 193, 217, 220

control of disease outbreaks, 35–36, 105–106

global polio eradication initiative, 183

grant administration, 27–28, 160–161, 203, 208, 215

immunization project grants, 27–28

immunization surveillance initiatives, 116, 117, 157, 184

incentive grants, 180, 210

infrastructure grants, 10, 90, 202

monitoring of disease reports by, 107

pockets-of-need strategy, 178–180, 192 nn.12–13

in projecting vaccine purchase needs, 14–15, 195, 223–224

provider definitions, 141 n.9

responsibilities, 91, 177

in Section 317 reauthorization, 214, 226

special population studies, 147

in state immunization programs, 6, 33, 160–161, 163, 165, 196, 216–217

state match requirements, 212–213

See also Section 317 program

Chicago, Illinois, 27, 30, 35, 67, 69

Child care centers, 133

Client-held medical records, 138

Clinical Assessment Software Application, 110, 113–114, 115, 157, 191 n.5

Clinics, public health, 8, 129–130

client trends, 166

educational intervention in, 137

historical role in immunization, 40, 142–143

immunization costs billed to client insurance carrier by, 94–95

limitations on free vaccination in, 97–98

referrals from managed care settings to, 62–63, 129–130, 166–168

role of, 40–41, 62, 99–100, 166

Section 317 spending by local health departments, 153

Clinton administration, 35, 117

College student immunizations, 55, 106

Community Health Network, 113

Community/Migrant Health Centers grants, 196

Congressional action, 176–177

recommendations for, 2, 195, 224, 225–226

Connecticut, 201

Cost of vaccine delivery

components, 21–24, 41, 42, 71, 100 n.1

to disadvantaged populations, 216

to final 10 percent of population, 47–50

full immunization, 94

local determinants of, 50

Medicaid coverage, 64, 78

Medicare reimbursement, 24, 86–87

obstacles to monitoring, 24–25, 122, 148

reimbursement issues, 63

VFC spending, 78

Cost of vaccines

client out-of-pocket costs as barrier to immunization, 129–130

determinants of, 100 n.1

full immunization, 21, 57, 94

influenza, 21, 89, 205

Medicaid coverage, 78

pneumococcal, 21, 89, 205, 227 n.4

public-sector discount, 21

trends, 57, 92

Council of State and Territorial Epidemiologists, 107

Coverage levels

1996 goals, 165

access to services as factor in, 133

accomplishments of national immunization program, 66

accountability issues, 150, 151

adult immunization, 4, 29, 69, 87, 217–220

among immigrant populations, 59–60

CDC pockets-of-need strategy, 178–180

challenges to improving, 4, 32, 146–148

client awareness intervention to improve, 136–138

cost determinants, 50

cost of achieving current levels, 19–29

current child levels, 19

current inadequacy, 3–4, 67–70

data sources, 110

disparities in adult vaccination, 69–70, 87, 218

disparities in childhood vaccination, 4, 29–31, 67–69

expanding access to services to improve, 129–133

extent of insurance coverage and, 74, 76–77, 144–146

focus on 2-year-olds, 19–21

goals, 1, 4

impact of budget reductions, 185

improving, 47

measurement methodologies, 110–115

in metropolitan areas, 4, 29–31

needs and performance measures, 17, 123, 146, 210, 226–227

NVAC recommendations to improve, 145

perceived acceptable levels, 108–109

potential scope of federal programs, 81–83

private-sector immunization delivery and, 9, 151

as private-sector performance measure, 146

provider-based interventions to improve, 133–136

reducing client costs to improve, 129–130

risk of outbreaks, 3, 34–36

role of national immunization system, 6, 43–46, 47

role of registries in documenting, 116–117

role of registries in improving, 117

strategies to improve, 47, 128–129, 138–139, 151, 154

system-level interventions to improve, 139–140

variation by state, 60, 67

D

Dallas County, Texas, 67

Delaware, 116

Development of new vaccines, 46–47

safety testing, 126

Diphtheria

surveillance, 107

vaccine, 55, 56, 66, 76–77

Disadvantaged populations, 177

cost of immunization, 216

disparities in coverage levels, 4, 29, 67–69

federal vaccine purchases for, 26, 38

health behavior, 216

monitoring coverage levels among, 63, 109, 113, 147

service delivery strategies, 178–180

service delivery trends, 188–189

state responsibilities, 11

targeted service delivery, 47–50, 216–217

See also Pockets of need; Vulnerable groups

Disease control and prevention

component activities, 105–107

disease report investigations, 107–108

government role, 65, 105–106

historical accomplishments, 18–19

impact of budget reductions, 183–184

monitoring of disease reports, 107, 108

outbreak risk, 3, 34–36, 50, 108–110

preventable mortality, 1, 4–5, 18, 29, 34, 35, 105

public health laboratory role, 107–108

use of sentinels, 105

See also Monitoring of immunization status

District of Columbia, 27, 93, 96

Drug resistant organisms, 59

E

Educational interventions

difficulties in, in current environment, 190

to increase community demand for vaccination, 136–137

by local health departments, 153–154

private sector support for, 173

with providers, 135–136

Employee Retirement Income Security Act (ERISA), 75, 78, 101 nn.3–5, 145

Extra-immunization, 110

F

Federal aid to states

for adult vaccination, 15, 205, 219

budgetary cycles, 16, 182, 203, 207

current spending, 26, 194–196

distribution among states, 208

finance practices, 177–183

grant reporting requirements, 16, 207

inadequacies in, 41–43, 142, 174, 187–188, 189

incentive grants, 91, 111, 177, 180, 208, 210–211

infrastructure support, 2, 9–10, 157–161, 176–178, 182, 189, 200, 207

instability in, 9–10, 32, 220–221

interaction of federal immunization efforts, 38

local health department operations, 152–153, 154–156

policy issues, 5–6, 33, 193

potential coverage of immunization programs, 81–83

purpose, 7–8, 11, 38–39, 175–176, 215

recommendations for formula approach, 2, 16–17, 208–215, 225–226

recommendations for infrastructure support, 2, 15–16, 224–225

for vaccine purchases, 8, 163, 177–178, 194–196, 200–201, 205

See also specific program

Federal–state partnership

accomplishments of, 3, 34, 66

basis for, 7–8

federal role, 38–39

goals for, 2

historical development, 39–40

information collection and management, 108

for infrastructure support, 108, 188

lack of strategic plan for, 5, 10, 32–33

Florida, 201

Formula for federal grants

base grant, 208

incentive awards in, 210–211

methodology, 213–215, 216

population factors, 209, 216

rationale, 208

recommendations for, 2, 16–17, 225–226

state capacity and need considerations, 209–210

state match requirement, 16, 211–213

G

Georgia, 199

Global population movement, 59

Goals

1996 immunization targets, 165

accomplishments of national immunization program, 66

adult immunization, 69, 217

coverage levels, 1, 4

difficulties in achieving coverage goals, 146–148

for federal–state partnership, 2, 38–39

financial resources for achieving, 142

full immunization schedule, 19–21, 55

National Immunization Program, 91

national immunization system, 6, 41, 43–46, 103–104, 193–194

for primary care delivery of vaccination, 144

vaccination access, 206

vaccine purchase, 206

Guam, 27

H

Head Start, 153, 155, 202

Health Care Financing Administration, 8, 26, 64, 73, 146, 168, 202, 206

Health Insurance Association of America, 51

Health maintenance organizations, 62

implications for adult immunization, 219

quality assessment and improvement requirements, 146

Health Plan Employer Data and Information Set, 114, 115, 227

Health Resources and Services Administration, 175, 196

Healthy People 2000, 217, 218–219

Healthy People 2010, 144

Hepatitis A vaccine, 55, 56

Hepatitis B surveillance, 107

Hepatitis B vaccine, 15, 55, 76–77, 219

for adolescents, 57

cost, 57

Medicare coverage, 86

Medicare spending, 29, 86

Hold harmless provisions, 16, 225

Home visits, 132

Houston, Texas, 27, 30, 35, 67

Human immunodeficiency virus, 105

I

Immunization Action Plan areas, 111, 178–179

Incentive awards, 111, 180, 208, 210–211

for client or family, 138

Section 317, 91

for states, 177

Indian Health Service, 196

Indiana, 67

Influenza surveillance, 107

Influenza vaccine, 76–77

adult coverage levels, 4, 29, 66–67, 69, 87, 89, 217, 218–219

child coverage levels, 66

cost, 21, 89, 205

coverage goals, 144–145

current recommendations, 21, 55, 57, 89

Medicare spending, 8, 26–29, 86

preventable mortality, 69

private insurance coverage, 76–77

recommendations for purchasing, 2

standing orders for, 135

Information management

client-held medical records, 138

for disease control and prevention, 105–106, 108

disease report investigations, 107–108

immunization registries, 116–122

in Medicaid, 63

in Medicare, 63, 87–89

monitoring of vaccine safety, 124–128

in private sector, 63, 147–150

for public health infrastructure, 104–105

state efforts, 174–175

technical compatibility, 119

See also Monitoring of immunization status

Infrastructure, public health

components, 103–104

cost components, 21–24, 41

current instability, 1, 3, 204, 206–207

definition, 104

effects of budget cutbacks, 168–169, 173

evolution of immunization program in, 72, 143

federal responsibility, 11, 221–222

federal support, 9–10, 96, 157–161, 176–178, 185–186, 187, 202–203, 207

inadequate support for, 187, 188, 191 n.7, 207

information requirements for, 104–105

laboratories, 107–108

local health department roles, 152–156

nonfederal assistance to states, 203–204

private health care system and, 103, 143, 203–204, 206–207

recommendations for funding, 2, 15–16, 195, 207, 211–213, 224–226

Section 317 grants for, 10, 91, 182–183, 202–203, 207

state match requirements for funding, 2, 211–213, 226

state roles and responsibilities, 11, 140, 156–157, 222, 226

state spending, 161–163, 165, 173, 174, 175, 197–199, 202, 206–207

variation by state, 8–9, 50, 174, 199

See also Cost of vaccine delivery

Insurance, private

for adult vaccination, 72, 77, 87

capitated payments, 62, 63, 77, 83, 85, 147

immunization coverage, 15, 41, 62, 72, 74, 75, 76–77, 94, 144–146, 191 nn.1–2

maintenance-of-effort requirements, 75–76, 76, 78

mandated coverage, 11–14, 74–76, 156, 205, 222–223

role of, in national immunization program, 11, 14

state vaccine purchase and, 8

types of residual needs, 73

See also Uninsured and underinsured persons

International immunization programs, 90, 177, 183, 187

L

Laboratories, 107–108

Local conditions, 34, 47

cost of service delivery, 50

implications for expanding coverage, 165

responsiveness of immunization system, 221

Local health departments

federal funding, 154–156

relations with state health departments, 155

roles and responsibilities, 153–154, 199

structure and operations, 152–153

Los Angeles, California, 35, 67

Louisiana, 218

Lyme disease treatment costs, 107

M

Maine, 51

Managed care, 34, 64

immunization data management, 25, 62, 114–115, 147–150

immunization service delivery, 62, 77, 85, 146–147

implications for adult immunization, 219

implications for public health infrastructure, 206–207

Medicaid enrollment, 62, 64, 83–85

Medicare enrollment, 87

NVAC recommendations for, 145

obstacles to expanding coverage in, 146–147, 149

referrals to public clinics from, 62–63, 166–168

in SCHIP, 83

state-mandated services, 83

Mariana Islands, 27

Marshall Islands, 27

Massachusetts, 67

Maternal and Child Health Services grants, 10, 90, 161, 199, 209, 226

Measles outbreaks, 3, 34, 35–36, 106, 109, 133

Measles surveillance, 107

Measles, mumps, rubella vaccine, 55, 66, 70

insurance coverage, 76–77

safety concerns, 125–126

Medicaid, 9, 17, 26, 35, 37, 38, 63, 72, 74, 106, 109, 145, 160, 197, 199, 226

barriers to immunization access, 99–100

eligibility, 85, 156

enrollment, 77, 85, 94

funds for infrastructure support, 161, 196

immunization benefits, 41, 77–78

immunization spending, 26, 78

managed care enrollment, 62, 64, 83–85, 206

monitoring of immunization coverage in, 13, 63, 113, 187–188, 210

obstacles to monitoring coverage in, 147, 149

outcomes and performance assessments, 146

potential participation, 81–83

residual need, 73, 211

state management, 50, 85, 146, 156, 163–164, 185, 200–201, 209–210, 213

Vaccines for Children program and, 64, 78–79, 97, 150, 221

Medicare, 26, 63, 72, 74, 106, 188

adult vaccination coverage, 8, 26–29, 194–196, 217, 219

immunization benefits, 86, 87, 89

information management, 87–89

managed care enrollment, 87

NVAC recommendations for, 145

vaccine reimbursement policy, 86–87, 102 n.23

vaccine spending, 24, 26–29

Meningitis surveillance, 107

Meningococcal vaccine, 55, 106

Metropolitan areas

disparities in vaccination coverage levels, 67, 69

federal funding to, 152–153

Immunization Action Plans for, 178–179

monitoring coverage in, 148

recent measles epidemic, 35

vaccination coverage, 4, 29–31, 34

Michigan, 42, 117, 148, 201

Micronesia, 27

Migrant populations, 59–60, 94

Military personnel, 196

Monitoring of immunization status

among disadvantaged populations, 63

challenges in, 60, 63, 122

client awareness intervention, 136

consistent and comparable measures for, 17, 123, 195, 226–227

cost of records management, 24–25, 122, 148

critical areas, 122–123

current inadequacies, 5, 32, 150–151, 187–188

effects of local conditions, 47

future challenges in, 66

in high-coverage areas, 122

historical development, 108–109

identifying geographic pockets of need, 110

impact of budget reductions, 184, 190

importance of, 50, 124

in local health departments, 154–155

measures for use in, 17

in Medicare managed care, 87–89

methodologies, 110–115, 123

private-sector immunization delivery and, 9, 14, 25, 63, 147–148, 151–152, 189, 223

problems in data management, 63, 64, 119–122, 123, 139

rationale, 11, 122, 139, 222

recommendations for improving, 2, 17, 195, 226–227

small-area studies, 109–110, 112–113, 123, 148

state efforts, 157, 160, 169, 174–175, 190

state responsibilities, 156

surrogate measures, 110

tools for, 47

use of registries in, 116–117, 119

Monitoring of vaccine safety, 124–128

Mortality/morbidity

disease trends, 18, 105

preventable infectious disease, 3, 4–5, 18, 29, 69–70, 105, 219

recent measles outbreaks, 3, 34, 35, 106

N

National Association of City and County Health Officers, 51, 153, 155

National Association of WIC Directors, 51

National Committee for Quality Assurance, 114

National Conference of State Legislatures, 51

National Governors' Association, 51

National Immunization Survey, 110, 111–112, 184, 227

National immunization system

accomplishments of, 3, 18–19, 34, 54, 66–67

ambiguities in leadership and administration, 65–66, 143, 174

complexity of, 47–50, 54, 61, 65–66

current inadequacy, 3–5, 10–14, 29–33, 34–36, 54

dynamic nature, 43

federal role, 11, 34, 36–37, 38–39, 64, 65, 174, 175–177, 215, 221, 222

fundamental roles, 6, 43–46, 47, 103–104, 193–194

future challenges, 60–61

historical development, 39–43, 54

impact of budget reductions, 183–185

infrastructure efforts in, 103–104

instability of, 1, 3, 10, 220–221

institutional relationships, 64, 65–66

need for comprehensive strategy, 10–11, 32–33, 221

policy issues, 5–6, 33, 193

private sector role, 11–14, 34, 64, 143, 144, 174

public agencies and organizations in, 64, 175

state role, 11, 34, 64, 65, 174, 221, 222

National Notifiable Disease Surveillance System, 107

National Vaccine Advisory Committee, 31, 145, 150, 179

purpose, 35

National Vaccine Injury Compensation Program, 126–128, 196

Native American, 37, 78

Nevada, 218

New Jersey, 50, 67, 85, 218

see also Newark

New York, 21, 27, 151, 218

Newark, New Jersey, 67, 148

North Carolina, 51

NVAC. See National Vaccine Advisory Committee

O

Outbreak risk, 3, 34–36, 50

clinical conceptualization, 108–109

pockets of need and, 109–110

P

Pennsylvania, 201

Pertussis

surveillance, 107

vaccine, 56, 66, 76–77

Pneumococcal vaccine, 17 n.2

cost, 21, 89, 205, 227 n.4

coverage goals, 144–145

coverage levels, 4, 29, 69, 86, 217–218

Medicare spending, 8, 26–29, 86

pediatric, 57

preventable mortality, 69

recommendations for adults, 21, 55, 89

recommendations for purchasing, 2

standing orders for, 135

Pockets of need, 4

federal infrastructure investments in immunization of, 176–177, 178–180

obstacles to identifying, 60

outbreak risk and, 109–110, 119

surveillance methods, 110

VFC effectiveness in, 37

See also Vulnerable groups

Polio, 18, 56, 66

surveillance, 107

worldwide eradication efforts, 177, 183, 187

Population movement, 59–60

Prevention. See Disease control and prevention

Primary health care

delivery of immunizations in, 62, 72, 223

goals for immunization delivery in, 37, 144

monitoring of coverage levels in, 189

preventive services in, 189

Private health care system

accountability for immunization coverage, 146, 150

adult vaccination coverage in, 144–145, 188

contributions to state infrastructure, 203–204

cost of vaccines, 21

federal action in, 177

immunization data management, 114–115, 149–150

interaction with federal immunization efforts, 38, 62–63, 64

mandated coverage, 222–223

monitoring of immunization status, 9, 14, 17, 63, 147–148, 149–150, 151–152, 189, 223

in national immunization program, 11–14, 34, 40–41, 43, 143, 144, 150, 174, 222

NVAC recommendations for, 145, 150

opportunities for improving coverage in, 152

public health infrastructure and, 103, 206–207

public health partnership, 151

quality assessment and improvement programs, 146, 189

referrals to public vaccination programs from, 129–130

service delivery in, 8, 61–63, 72, 129–130, 166, 188, 189, 200

state management and oversight of, 157–160, 177

See also Insurance, private; Managed care

Public awareness and understanding

of immunization status, 136

obstacles to, in current environment, 190

safety of vaccines, 128

Public Health Service block grants, 161, 196

Puerto Rico, 27

Q

Quality assessment and improvement, 146

R

Race/ethnicity

disparities in adult vaccination coverage, 4, 69–70, 87, 218

disparities in child vaccination coverage, 67

Registries of immunization, 157, 204

barriers to development and implementation, 119–122, 124

benefits, 119, 123–124

compatibility issues, 117, 119–122

definition, 116

efforts to date, 116–117, 123

fully functional, 141 n.6

funding for, 184

ideal components, 117

national system, 117

provider participation, 117

role in improving coverage levels, 119

Reminder–recall intervention

client, 136, 139, 154, 179

provider, 134

Reminder–recall–outreach intervention, 151

Residual needs, 94

determinants of, 99–100

examples of, 73

federal funding for, 15, 224

future challenges, 98–99, 205–206

state responses, 11, 100, 164–165

See also Disadvantaged populations; Pockets of need; Uninsured and underinsured persons; Vulnerable groups

Rhode Island, 67

Rotavirus vaccine, 56, 125, 201

Rubella infection, 107. See also Measles, mumps, rubella vaccine

S

Safety of vaccines, 47, 177

adverse events, 60, 124–125, 126, 127, 141 n.11

monitoring, 124–128

public awareness and understanding, 128

San Antonio, Texas, 27

San Diego, California, 51

Schedule of vaccinations, 46–47

changes in, implications for service delivery, 14–15, 60–61, 66, 190, 195, 223–224

concerns of universal purchase states, 98

current, 21, 55

delay between vaccine approval and availability, 60, 79, 100

provider reminder–recall, 134

rate of change in, 55, 57

recent changes in, 55–57

state requirements, 137, 145–146

SCHIP. See State Children's Health Insurance Program

School-based immunization, 112, 132–133, 156

Section 317 program, 112, 152, 188–189, 194

accomplishments of, 8

administrative problems for states, 203

adult vaccination funding, 90, 219

budget cutbacks, 168–169, 176, 177–178, 182–183, 190, 203

carryover of funds, 51, 180–183, 203

current funding mechanism, 27–28, 90

formula funding mechanism, 2, 16–17, 195, 208–215, 216, 225–226

historical development, 89–90

immunization coverage under, 90–91

incentive awards, 91, 210–211

infrastructure grants, 2, 10, 90, 91, 157–161, 165, 176, 177–178, 182–183, 185–187, 187, 200, 202–203, 207

interaction of federal immunization efforts, 38, 97, 99

level of funding for, 90, 185

local health department funding, 153

outbreak control funding, 183–184

pockets-of-need strategy, 178–180

policy issues, 5–6, 33, 193

program operations, 90, 185–186

provisions, 17 n.1

purpose, 26, 36–37, 43, 72, 89–90, 91–92, 176, 199, 209

reauthorization, 214, 226

recommended funding for, 2, 14, 15, 195, 207, 224

resource allocation, 38, 91, 165, 177–178, 185–187, 200, 202

SCHIP and, 38, 51, 196

special population studies under, 147

state match requirements, 9, 212

vaccine purchases, 8, 61, 90–91, 95, 177–178, 200, 201, 223–224

VFC program and, 38, 90

Section program, 2, 5

Settings for immunization

comparisons of coverage, 110

current distribution, 61–62

dispersion of responsibilities, 64

historical evolution, 39–41

implications for monitoring coverage, 63, 64, 122

nonmedical, 131–133

primary care provider, 62

private sector, 61–63, 188

service delivery trends, 8, 188

strategies for expanding access, 130–131

Small-area immunization studies, 109–110, 112–113, 123, 148

Smallpox, 18, 57–59

Social benefits of immunization, 71

Social service programs

access to immunization in, 131–132

identifying underimmunized populations through, 35

linkage with immunization program, 32, 41, 154, 155

state infrastructure funding from, 161

Socioeconomic status

disparities in vaccination coverage levels, 4, 29, 67, 129

obstacles to improving coverage disparity, 32

trends, 166

utilization of public clinics, 129–130

Standing orders, 135

State Children's Health Insurance Program (SCHIP), 9, 17, 26, 41, 74, 143, 145, 149, 154, 160, 206

capitated insurance programs and, 83, 85

coordination with other vaccine programs, 185, 211

coverage policies, 83, 101–102 n.17

enrollment trends, 62

grant allocation, 79

interaction of federal immunization efforts, 38, 83

managed care arrangements, 83

monitoring of immunization coverage in, 187–188, 210

performance monitoring, 109

policy issues, 5

potential participation, 81–83

public health infrastructure support in, 196

purpose, 38, 79, 106, 196

residual need, 72, 73, 94, 211

Section 317 and, 38, 51, 196

state administrative practices, 79–81, 85, 146, 156, 180, 209–210, 213

Vaccines for Children program and, 166, 202, 221

State immunization programs

administration of local health departments, 153

adult vaccination, 224

allocation of federal funds among, 208

core functions, 43, 160–161

current inadequacy, 1, 32, 174

current obstacles to service delivery, 189–190

efficient use of federal funds, 210–211

eligibility for free vaccines in, 97–98

federal infrastructure grants, 9–10, 13

federal role in, 7–8, 175–176

finance practices, 163–168, 182

future prospects, 1, 190–191

impact of budget reductions, 183–185

infrastructure problems, 204

infrastructure spending by, 2, 8–9, 29, 50, 161–163, 174, 175, 197–199

linkage with other service programs, 32

Medicaid administration, 78, 146

policy issues, 5–6, 33, 193

private-sector management and oversight, 157–160

quality assessment and improvement programs, 146

recommendations for adult vaccine spending, 2, 15, 195, 224

recommendations for infrastructure funding, 2, 15–16, 195, 207, 224–225

recommendations for monitoring, 2

recommendations for Section 317 funding mechanism, 2, 16–17, 208–215, 225–226

required vaccination, 137, 145–146

requirements for private insurance coverage, 74–75

requirements for private-sector data management, 149

resource allocation, 100, 157–161, 163–164, 165–166, 169, 173, 180, 197–199, 200–201

response to budget reductions, 9–10, 168–169, 173, 174, 180, 189, 203

response to residual needs, 11, 100, 164–165

roles and responsibilities, 7, 156–157

SCHIP administration, 79–81

Section 317 grants, 90, 91–92, 157–161, 165, 182–183, 185–187, 199, 203

vaccine purchases, 2, 8, 10, 29, 61, 91–95, 163, 196–199, 200–201, 205

variation by state, 8–9, 49–50, 60, 67, 93–95, 164–165, 174, 199

VFC provisions, 78–79, 95–97, 166

T

Task Force on Community Preventive Services (TFCPS), 128–129, 130–131, 132, 133, 134, 135–136, 137, 138, 139

Temporary Assistance for Needy Families, 161

Tetanus surveillance, 107

Tetanus vaccination, 15, 55, 56, 66, 76–77

adult booster, 219

Texas, 67

See also Dallas County, Houston

Thimerosal, 125

Title V grants, 196

Tuberculosis, 59

U

Uninsured and underinsured persons

current estimates of, 74, 77, 94

high-risk adults, 87

private health care enrollment, 94

recommendations for funding, 15

residual need, 94

SCHIP for, 38

vaccine delivery, 8

VFC program for, 37, 78, 95, 96

Universal purchase programs, 8, 72, 97, 201, 202

cost of additions to immunization schedule, 98

Utah, 201

V

Vaccine Adverse Events Reporting System, 126

Vaccine purchases

current inadequacies, 1, 205–206

federal programs, 36, 37, 61, 64, 187

federal spending, 8, 26–29, 194–196, 205

projected needs, 14–15, 195, 223–224

recommended federal funding for, 14, 15, 195, 224

role of national immunization system, 6, 43

under Section 317, 90–91, 177–178, 200, 201

Section 317 savings for states, 200

state immunization programs, 163

state spending, 8, 10, 29, 61, 91–97, 196–199, 200–201, 205

under VFC program, 78, 81, 187, 223–224

See also Cost of vaccines

Vaccines for Children (VFC) program, 8, 9, 26, 36, 64, 72, 74, 92, 129, 145, 154, 160, 166, 188–189, 194

accomplishments, 37

administrative costs, 201–202

coverage policies, 78, 83, 95, 101 nn.10–11, 221

enhanced programs, 96

future challenges, 98–99

health care provider enrollment, 63, 78

increases in coverage associated with, 130

interaction with other vaccination programs, 38, 83, 97, 166, 185

limitations, 37, 43, 85, 180

Medicaid and, 64, 78, 79, 97, 150, 166, 200, 221

monitoring of immunization coverage in, 187–188

performance monitoring, 109

potential participation, 81–83

prior to, 92

provider participation, 64

purpose, 37, 43, 72, 78, 161

recommended federal funding, 14, 223–224

referrals, 129–130

requirements for states, 78–79

residual need, 73, 94, 98–99

resource management by states, 161, 163–164

role of public health agencies in, 143

SCHIP and, 166, 202, 221

Section 317 program and, 38, 89

vaccine purchase savings for states, 93, 97, 200

vaccine purchases, 26, 61, 78, 93, 95, 223–224

Varicella vaccine, 55, 56, 77, 79

cost, 57

coverage rate, 60

delays in availability, 60, 79, 100

Vermont, 67

VFC. See Vaccines for Children program

Virgin Islands, 27

Vulnerable groups, 33

monitoring coverage in private sector, 9, 63, 147, 149–150, 151, 152

monitoring needs, 66, 151

service delivery trends, 188–189

state role in monitoring, 11

surveillance methods, 112–113

trends, 66

See also Disadvantaged populations; Pockets of need

W

Washington, 111–112, 201

West Nile-like virus, 59

Women, Infants, and Children (WIC) program, 10, 32, 35, 41, 64, 131–132, 138, 153, 154, 155, 157, 161, 199, 202

in CDC interventions in low-coverage areas, 179–180