tices (ACIP), which is authorized by the Public Health Service Act to provide advice and guidance to the Secretary of Health and Human Services, the Assistant Secretary for Health, and the director of the Centers for Disease Control and Prevention (CDC).

FRAMING OF GOAL 4

The nine objectives (see Box 4-1) in this goal range widely from ensuring consistent and adequate availability of vaccines to maintaining “a strong, science-based process for developing and evaluating immunization recommendations” (see Chapter 3, which discusses the importance of better communication of how immunization policies are made).

This chapter offers discussion and recommendations intended to help focus Goal 4 on addressing a narrower set of challenges and on a priority action pertaining to each major challenge to the effective use of vaccines for children, adolescents, and adults. Major types of challenges are described below.

Some barriers to effective use of vaccines stem from the lack of affordability of certain newer vaccines (e.g., HPV [human papilloma virus] vaccines recommended for young women, varicella zoster vaccine recommended for older adults) for significant numbers of patients. Not all private insurers cover such vaccines, and patients may be unwilling or unable to incur an out-of-pocket cost.

There are challenges that stem from the failure of health care financing (whether via public and private insurance or through direct grant financing by the federal government) to ensure that health care providers are adequately reimbursed for the purchase and provision of vaccines (Freed et al., 2008a,b). Related to these challenges are problems associated with vaccine production and interruption of the supply of vaccines available (Hinman et al., 2006; IOM, 2003). Another Institute of Medicine (IOM) committee has described the “tensions [that] exist between the need to control public and private expenditures on vaccines and the need to encourage investment in their development” (IOM, 2003). In other words, inadequate financing for vaccines and related costs have played a role in decreasing the attractiveness of the vaccine market to companies and investors.

Another category of challenges relates to system performance in the delivery of immunization services. Health plans have had some success using pay-for-performance approaches to incentivize provider practices that led to increased immunization rates (AHIP, 2009). However, incentives for high performance in immunization within the health care system are lacking (Berman, 2005), as is clear evidence about what works to motivate high performance. The Centers for Medicare & Medicaid Services (CMS) require managed care organizations to submit Healthcare Effectiveness Data



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