As part of that exercise, the committee also encourages state and federal immunization policymakers to include a discussion of state mandates for vaccine use. The committee is encouraged by an activity, tentatively called the “Workgroup on Public Health Options for Implementing Vaccine Recommendations,” currently underway by the National Vaccine Advisory Committee (NVAC) of the National Vaccine Program Office (NVPO). The exact nature of that activity—its scope, timetable, and authority to initiate action—are not clear, but it appears to be an important first step toward this dialogue. The committee hopes that this important activity remains a priority for NVPO and NVAC, even as other timely vaccine-related issues influence the agenda. Such issues require long-term planning and evaluation; a reactive response to the next schedule addition will be much less effective than a proactive assessment and strategy development across the board.

As part of this overall effort, the committee encourages an exploration of the merits of accommodating requests for alternative vaccine dosing schedules and the development of appropriate clinical guidance for any such alternatives. A more flexible schedule might allow for a reduction in the number of vaccines administered at one time. Such a change would respond to some concerns about multiple immunizations; but it could also have disadvantages, such as requiring more health care visits, that might contribute to lower rates of immunization coverage in the population and consequent increases in morbidity and mortality. In addition, such a change would require extensive communication with healthcare providers and health plans in order that appropriate immunizations occur and are compensated as much as they are for the “traditional” schedule. A more flexible schedule might also permit innovative epidemiological research that currently is difficult because of the homogenous immunization schedules now extant in the United States. If more flexible schedules do gain acceptance, policymakers must ensure that those options are equally available to children who receive immunizations in public clinics and those who are served by private providers.

By issuing the recommendation listed above, the committee does not intend to signal concern about health consequences of the multiple immunizations in the recommended childhood immunization schedule. In fact, the committee does not recommend a policy review—by the CDC’s Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics’ Committee on Infectious Diseases, and the American Academy of Family Physicians—of the current recommended childhood immunization schedule on the basis of concerns about immune system dysfunction.

Similarly, the committee does not recommend a policy review by the Food and Drug Administration’s Vaccines and Related Biologic Products Advisory Committee of any currently licensed vaccines on the basis of concerns about immune system dysfunction.

The committee’s review of evidence regarding multiple immunizations and immune system dysfunction provides no basis for recommending



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