Setting the Course A Strategic Vision for Immunization: Part 4: Summary of the Washington, D.C., Workshop (2003) / Chapter Skim
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Building the Immunization Infrastructure
Building the Immunization Infrastructure
Pages 15-24
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From page 15... ...
report on future finance strategies to support the immunization system. The speakers included Donald Williamson, director of the Alabama Department of Public Health; Natalie Smith, director of the Immunization Program for the state of California; Dianne White Delisi, state legislator from the Texas State House of Representatives; and Jonathan Fielding, director of the Los Angeles County Health Department.
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From page 16... ...
The IOM recommendations were consistent with a 1999 report by the National Vaccine Advisory Committee, which called for a $200 million annual budget for the state infrastructure program. At the state level, the IOM report provided a vehicle for conversations about the complexity of immunization infrastructure and provided an important rationale to support state advocacy efforts for increases in public health budgets.
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From page 17... ...
In some cases, the public health department will supplement federal vaccine programs with purchases from state revenues (this was done in purchasing hepatitis A and pneumococcal conjugate vaccine)
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Many new political leaders have emerged who are unfamiliar with public health concerns and the intricacies of the federal-state financial partnership. The impact of increasing Medicaid expenses resulting from both increased costs as well as wider enrollment cannot be ignored because these higher expenses are a key factor in state funding increases for health.
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From page 19... ...
The development of immunization registries, for example, requires financial assistance if local health departments are to improve their monitoring and surveillance of key health indicators. Yet it is difficult for counties to bear these infrastructure costs when they are also expected to cover safety net services for indigent populations.
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From page 20... ...
The survey data provide a deeper understanding of the rationale behind key decisions at the state level, the major influences on state immunization program goals and priorities, the effects of federal policies and fluctuations in federal funding on state programs, and other factors affecting state immunization efforts in the 1990s. The survey results focus on three key areas: vaccine purchase, immunization program infrastructure, and other programs and regulations.
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From page 21... ...
Once again, each system represents different approaches and different levels of investment that frequently reflect variations in the historical public health traditions and resources of each state. Under VFC-only programs, states rely solely on federal vaccine purchase funds to supply vaccines to eligible children in public and private health settings.
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From page 22... ...
In response to the measles epidemics of 1989 and 1990, the federal government appropriated funds to help states develop Immunization Action Plans to improve their immunization rates, especially for children. The 1993 Children's Immunization Initiative subsequently increased funding to support infrastructure investments and allowed states to expand their immunization programs.
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From page 23... ...
State survey respondents indicated that national leadership must include flexibility for the unique and specific situations that occur across the states and allow greater discretion in establishing immunization priorities at the state level. CASE STUDY FINDINGS In addition to the 50-state survey, the IOM Committee on Immunization Finance Policies and Practices commissioned a set of eight case studies of state and local immunization programs to examine how states incorporate federal funds (particularly Section 317 grants)
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From page 24... ...
New activities associated with infrastructure investments include investments in immunization registries, quality improvement, coordination with program staff outside public health agencies, and assurance of ageappropriate immunization throughout the lifespan. The declining levels of Section 317 budget awards to the states have forced many health departments to make difficult choices between the continuation of older, mainstream immunization services and newer coordinating and program outreach efforts at the state and local levels.
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