Concluding Observations
The workshop concluded with observations from Bernard Guyer and Molly Droge. Dr. Guyer, from the Johns Hopkins Bloomberg School of Public Health, chaired the IOM committee that produced Calling the Shots. He commended the workshop speakers and participants for identifying critical problems for immunization finance in Texas and for proposing constructive responses. Noting that immunization policy in the United States has been characterized by cycles of crisis and complacency, Dr. Guyer observed that the relative complacency that had developed since the measles epidemic from 1989 to 1991 has ended with the terrorist attacks of September 11, 2001, and the subsequent evidence of bioterrorism.
The new concern about health security is drawing attention to the importance of the public health infrastructure. The core public health resources—including laboratories, disease surveillance systems, and trained staff—that are needed for ongoing disease prevention efforts must be in place to respond to new public health threats. The quality of the immunization system can be seen as an indicator of the strength of the public health infrastructure. If the nation cannot ensure that the 11,000 children born each day receive the routine immunizations that they need, it may not be able to adequately protect the health of all 280 million Americans in times of crisis. Although crisis can stimulate action, sustained efforts are necessary to maintain the public health infrastructure and achieve immunization goals.
Dr. Guyer found that the workshop discussions of immunization is-
sues in Texas offered valuable lessons for all who want to strengthen the nation’s immunization system. Adequate funding is necessary for immunization programs, but it is not sufficient to guarantee success. Similarly, no one agency or group in the public or the private sector should expect, or be expected, to solve immunization problems alone. Collaboration, consultation, and partnerships across levels of government and between the public and private sectors are essential for the efforts made to achieve immunization goals to be effective. The workshop underscored the importance of learning from the experience of private providers, who see critical barriers and limitations in both public and private financing for the purchase of vaccines and payment for immunization services. Also evident from the workshop discussions is the need for immunization supporters in the public health community—in health departments as well as in academia—to communicate more effectively with key partners in the private sector. For example, immunization policy makers and program managers must work more closely with health plans and employers to ensure that immunization recommendations and goals are clear. Furthermore, problems of vaccine shortages and vaccine distribution must be addressed. Finally, Dr. Guyer urged building on the strong public support of immunization, which was evident at the workshop, to achieve the desired changes and improvements in the operation and financing of immunization programs.
Looking specifically to Texas, Dr. Droge, president of the Texas Pediatric Society, pointed to several next steps suggested by the workshop. Legislative support will be essential to efforts to improve the effectiveness of the immunization system, such as making modifications to the immunization registry. Representative Delisi’s participation in the workshop and representation by other state legislative offices in the workshop were seen as an encouraging signal. Within the provider community, more can be done to make immunization a priority and to encourage participation in immunization programs such as VFC. Efforts are needed to reach not only pediatricians and family physicians but also internists, who serve an underimmunized adult population. The workshop helped reveal the complexity of the current approach to immunization finance and service delivery in Texas, with a patchwork of various federal and state programs for insurance and vaccine purchase, combined with the diversity of private-sector insurance and health care delivery. Dr. Droge urged workshop participants to work toward simplifying this system. As part of that effort, she encouraged them to explore the feasibility of a universal vaccine purchase program for Texas that might be built on a public-private partnership, drawing not only on public funding from federal and state sources but also on private funding from health plans, insurers, employers, and other purchasers of health care services.
