in the 1993 Omnibus Reconciliation Act (Public Law 103-66) included the establishment of the Vaccines for Children Program, an entitlement program that provides free vaccine for children who are Medicaid eligible, uninsured, underinsured for immunization services (i.e., individuals whose insurance policy covers only some or no vaccines), or are American Indian or Alaska Native.

Vaccine cost, cost-effectiveness, and financing are among the important and complex considerations that inform policy decisions about the use of vaccines to prevent disease, disability, and death as a component of national and state public health policies. The use of vaccines has implications not only for the health of individuals and communities (i.e., in preventing spread of disease) but it also has multi-faceted implications for the health care delivery system, employers, schools, and parents. Vaccines have long been known to be cost-effective, and older vaccines (introduced before 2000) are also cost-saving. Newer, more expensive vaccines are cost-effective but not cost-saving. A 2008 NVAC report noted that the considerable increase in the cost of providing all ACIP-recommended childhood vaccines (a 336 percent increase in vaccines for males and 476 percent in vaccines for females) “has raised concerns about the ability of the current public and private vaccine delivery systems to maintain access to all vaccines recommended for routine use in children and adolescents without financial barriers” (NVAC, 2008). Medical practices, public health clinics and other settings where vaccination is administered also incur significant and growing non-vaccine costs that include counseling, storage, administration, and staff time. Reimbursement for these costs is frequently inadequate. At the global level vaccine financing issues are different than in the United States (see Chapter 5), but are similarly complex. NVAC, the IOM, and several professional societies such as the American Academy of Pediatrics have examined these interrelated problems of vaccine financing and have proposed solutions (AAP, 2007; IOM, 2000, 2003; NVAC, 2009).


AAP Task Force on Immunization. 2007. Discussion Paper: Immunization Financing: Where is the Breaking Point? Available: [accessed July 12, 2009].

Colgrove, J., and R. Bayer. 2005. Could it happen here? Vaccine risk controversies and the specter of derailment. Health Aff 24(3):729-739.

HHS (Department of Health and Human Services). 1994. 1994 National Vaccine Plan. Available: [accessed January 2008].

HHS. 2008 (November). Draft Strategic National Vaccine Plan. Available: [accessed December, 2008].

House of Representatives. 1995 (March 8). Hearings before the Committee on Appropriations, 104th Congress, First Session. Subcommittee on the Departments of Labor, Health and Human Services, Education, and Related Agencies Appropriations for 1996.

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