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Calling the Shots: Immunization Finance Policies and Practices
The Institute of Medicine (IOM) Committee on Immunization Finance Policies and Practices has therefore concluded that a renewal and strengthening of the federal and state immunization partnership is necessary. The goal of this renewed partnership is to prevent infectious disease; to monitor, sustain, and improve vaccine coverage rates for child and adult populations within more numerous and increasingly diversified health care settings; and to respond to vaccine safety concerns. To achieve this renewal, states require a consistent strategy, additional funds, and a multiyear finance plan that can help expedite the delivery of new vaccines; strengthen the immunization assessment, assurance, and policy development functions in each state; and adapt childhood immunization programs to serve the needs of new age groups (especially adults with chronic diseases) in different health care environments.
The IOM committee recommends that federal and state governments adopt a national finance strategy that would allocate $1.5 billion in federal and state resources over the first 5 years to strengthen the infrastructure for child and adult immunization—an annual increase of $175 million over current spending levels. These resources would consist of $200 million per year in state infrastructure grants awarded by the Centers for Disease Control and Prevention (CDC) (the Section 317 program) and an additional $100 million per year in increased state contributions. The committee also recommends that Congress replace the current discretionary Section 317 grants with a formula approach for state immunization grant awards to improve the targeting and stability of federal immunization grants. The formula should provide a base level of support to all states, as well as additional amounts related to each state’s need, capacity, and performance. The committee further recommends that Congress introduce a state match requirement for the receipt of increased federal funds to help strengthen and stabilize the infrastructure that supports long-term public health assessment, assurance, and policy development efforts.
Along with the development of a strategic investment plan to support immunization infrastructure, the committee recommends that the federal government provide $50 million in additional funds to help states purchase pneumococcal and influenza vaccines for adults under age 65 who are not eligible for other forms of public health insurance and who have chronic illnesses such as heart and lung disease or diabetes. The committee further recommends that states increase their own vaccine purchases by $11 million annually for adults who cannot afford vaccines but are not eligible for federal assistance (the “underinsured”). Finally, the committee recommends that federal and state agencies develop a set of consistent and comparable measures to monitor the immunization status of children and adults enrolled in public and private health plans.