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Priorities for the National Vaccine Plan
offers several concepts that may be useful to understanding the role and potential of NVPO. The National Vaccine Program is an interorganizational network—a set of federal organizations linked by common purpose in relationships that vary in strength and complexity (Provan et al., 2007). The literature describes entities such as NVPO as network administrationorganizations (Provan et al., 2007) or as coordinating units (Alexander, 1993). These terms refer to entities created expressly to support and facilitate coordination and collaboration among the organizations in a network; these entities generally do not have any “line” functions and are not responsible for implementing any of the tasks they are charged with coordinating (Alexander, 1993). However, entities charged with facilitating interorganizational coordination have the potential to be powerful and effective under certain conditions. Notably, a balance of authority and resources is needed to enable such entities to be effective—“If it has decision-making power but lacks implementation resources, the coordinating unit may suffer a ‘crisis of competence;’ if it controls resources but lacks authority, it may encounter a ‘crisis of legitimacy’” (Alexander, 1993:337). As discussed in this chapter and elsewhere in the report, NVPO has neither sufficient authority to “coordinate and provide direction”5 nor resources to accomplish its statutory responsibilities and optimally support the various roles it plays as a coordinator both within government and with stakeholders.
Interorganizational networks use a variety of formal and informal tools to facilitate coordination, including agreements, contracts, and plans (Alexander, 1993; Graddy, 2008; Provan et al., 2007). The coordinating tool for the National Vaccine Program is the National Vaccine Plan, but as noted in this report, it has been underused.
The need for high-level coordination in important areas of the National Vaccine Program has been noted by a Congressional Research Service report that described the large group of federal agencies with roles in vaccines and immunization but noted that “[t]here is no central federal authority for vaccine policy” (Thaul, 2005),6 and has been noted repeatedly by NVAC (NVAC, 2009; Appendix B). Over the years, there have been efforts at different levels to coordinate the actions of government agencies responsible for vaccine and immunization policies and programs. The large and complex network of government agencies and diverse stakeholders understandably requires a variety of mechanisms, processes, and groups to achieve some shared goals. Examples of prior or existing entities created within the National Vaccine Program include the Interagency Vaccine Group, an ongoing activity, and the Task Force on Safety of Childhood Vaccines, a temporary group that produced an important report on vaccine safety (NIAID, 1998).
National Childhood Vaccine Injury Act, Public Law 99-660.
Similarly, a 1993 report of the HHS Office of the Inspector General described NVPO’s mission as “bring[ing] coherence to a fragmented immunization system” (OIG, 1993).