Setting the Course A Strategic Vision for Immunization: Part 4: Summary of the Washington, D.C., Workshop (2003) / Chapter Skim
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A National Perspective on the Immunization System
A National Perspective on the Immunization System
Pages 6-14
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Within this system, vaccines are either sold directly to health care providers or are purchased by public health agencies and then distributed to the providers through state-ad· · . · · m~n~sterecr ~mmun~zahon programs.
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However, the instability of federal and state roles within this system has grown in recent years, diminishing the capacity of health care providers to adapt to patterns of rapid acceleration in vaccine science, the emergence of new health care arrangements for disadvantaged populations (such as the creation of the new State Children's Health Insurance Plan) , and the immunization needs of adolescents and adults.
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William Schaffner from Vanderbilt University, a member of the program committee for the IOM workshops, commented that the expectation of a prompt response from the states in addressing problems within the immunization infrastructure may be unrealistic. The lack of cultural memory of disease outbreaks, in particular, leads to passivity and complacency in supporting ongoing immunization efforts.
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· Private health care plans and providers have the capacity to do more in implementing immunization surveillance and preventive programs within their health practices, but such efforts require additional
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influenzue type bb Hepatitis Ab Hepatitis Bb Varicellab Pediatric conjugate of pneumococcal polysaccharide Borrelia burgdorferi Meningococcal polysaccharide A,C,Y,W-135 Measles, mumps, rubella, and varicellaC Eradication of polio expected Hibc Hepatitis Ac Hepatitis Be Varicella with MMR Pediatric conjugate of pneumococcal polysaccharideC Borrelia burgdorferi Conjugated meningococcal polysaccharide A,B,C,Y,W-135C Adult tetanus, diphtheria, acellular pertussis, and componentsC Chlamydia Coccidioides immites Cytomegalovirus Enterotoxigenic E.coli Epstein-Barr assistance, oversight, and incentives. At the same time, comprehensive insurance and high-quality primary care services do not replace the need for public health infrastructure.
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Multiple sclerosis (therapeutic) Mycobacterium tuberculosis Neisseria gonorrhea Neisseria meningitidis B ParainfluenzaC Respiratory syncytial virusC Rheumatoid arthritis (therapeutic)
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Under estimates of need, for example, multiple measures might be included in the following areas: population size, birth cohort, percentage of immigrants, rurality, level of poverty, and immunization levels. CDC has also reduced federal grant reporting requirements from 18
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Dr. Orenstein observed that several topics emerging in the regional workshops based on the IOM report have also drawn attention from CDC.
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The new vaccine finance study will examine the roles and responsibilities of the public and private health sectors in the purchase and administration of vaccines, and will consider alternative finance strategies from multiple perspectives, including the role of such strategies in achieving national health goals, in the service delivery mechanisms for various vaccines and population groups, in delivering recommended vaccines to underserved populations, in reducing the time lag and disparities associated with the introduction of new vaccines to the recommended schedule, and in addressing the effects of multiple new vaccine products. This study will begin in late 2000 and is expected to produce a final report in 2003.
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