of Medicine (IOM) committee (provided in Appendix B) the National Vaccine Advisory Committee (NVAC) urged the IOM committee to comment on NVPO’s coordinating role with regard to the National Vaccine Plan, including interagency and interdepartmental coordination and coordination with external stakeholders.

In this chapter, the committee examines what it considers the inextricable link between NVPO’s effectiveness to coordinate and the plan’s success, and develops the rationale for strengthening NVPO to ensure successful implementation and maintenance of the National Vaccine Plan as a tool for coordination on critical issues in the national vaccine program.3 This chapter also discusses several case studies that illustrate the effects of a lack of coordination: unmet challenges and unmet statutory responsibilities.

COORDINATION: ESSENTIAL TO PLAN SUCCESS

The IOM committee received input from multiple stakeholders on NVPO’s role, authority, and resources and its ability to coordinate on communication and research prioritization (IOM, 2009a,b,c). NVPO’s role and effectiveness also have been reviewed and discussed by Cooper et al. (2008), and were the subject of an evaluation conducted by RAND Corporation. RAND found that NVAC’s role and effectiveness have suffered as a result of the fact that NVPO is underfunded and understaffed (Ringel et al., 2009).

The committee believes that coordination will not occur in areas where it is needed in the absence of a federal entity that can support it, and that the 1986 National Childhood Vaccine Injury Act (NCVIA) defined such an entity and outlined its responsibilities. NVPO was established to comply with the act but has not been given the opportunity to play the crucial role described in the statute (i.e., “coordinate and provide direction” to relevant government agencies in several areas of the National Vaccine Program).4 It was not given the resources described in the act or the authority needed to motivate and facilitate coordination on major challenges facing the U.S. immunization effort in the past two decades.

Public administration literature on interorganizational coordination

3

In this report, the committee uses national vaccine program in lower case to denote the vast and complex network of actors and actions related to vaccines and immunization, and uses National Vaccine Program (per the 1986 act) when referring to the governmental agencies that have responsibilities related to vaccines and immunization.

4

The 1986 act charged the National Vaccine Program (whose operational arm is NVPO) with coordinating and providing direction in the areas of vaccine research, vaccine development, safety and efficacy testing of vaccines, licensing of vaccine manufacturers and vaccines, distribution and use of vaccines, evaluating the need for and the effectiveness and adverse effects of vaccines and immunization activities; with coordinating governmental and nongovernmental activities; and with funding of federal agencies in implementing the National Vaccine Plan.



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