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Index
A
Adult vaccination, 177
coverage levels, 4, 29, 69, 87, 217– 220
current schedule, 21, 55
disparities in coverage, 4, 69–70, 218
federal government, 205, 219
high-risk populations, 4, 29, 87, 205, 218–219
immunization program needs, 2, 15, 195, 205, 219–220, 224
insurance coverage, 72, 77, 87, 89, 144–145, 219
Medicaid coverage, 83–84, 87–89
Medicare coverage, 86
Medicare spending, 8, 94–196
Section 317 program for, 90, 219
Adverse reactions, 60
Advisory Committee on Immunization Practices (ACIP), 14, 15, 21, 23, 55, 57, 64, 71, 74, 77, 78, 106, 125, 157, 205, 224
implementation of recommendations, 78–79, 98– 99, 201
recommendations for adult vaccination, 89
Aid to Families with Dependent Children, 35
Alabama, 50, 201
Alaska, 37, 78, 106, 218
American Academy of Family Physicians, 23, 57
American Academy of Pediatrics, 23, 24, 51, 55, 57, 74, 125
American Association of Health Plans, 51
American Medical Association, 57
American Samoa, 27
Antibiotic resistance, 59
Arizona, 218
Arkansas, 67
Assessment, assurance, and policy development
government role, 11, 103
national immunization strategy, 2, 39–43
private-sector role, 104
See also Infrastructure, public health
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Assessment and feedback intervention, 42, 134–135, 139, 179
Association of Maternal and Child Health Programs, 51
Association of State and Territorial Health Officers, 51
Autism, 125–126
B
Belau, 27
Birth rate, 4, 19
Bush administration, 35–36
C
California, 83, 115, 147, 201
See also Los Angeles, San Diego
Capitated payments, 62, 63, 67, 83, 85, 147
Carryover of funds, 51, 180–183, 191 n.6, 192 n.14, 203
Carter administration, 35
Case studies, 51, 263–270
See also specific site
Centers for Disease Control and Prevention, 2, 5, 8, 26, 64, 79, 113, 119, 125, 168, 175
adult vaccination role, 6, 33, 193, 217, 220
control of disease outbreaks, 35– 36, 105–106
global polio eradication initiative, 183
grant administration, 27–28, 160– 161, 203, 208, 215
immunization project grants, 27– 28
immunization surveillance initiatives, 116, 117, 157, 184
incentive grants, 180, 210
infrastructure grants, 10, 90, 202
monitoring of disease reports by, 107
pockets-of-need strategy, 178–180, 192 nn.12–13
in projecting vaccine purchase needs, 14–15, 195, 223–224
provider definitions, 141 n.9
responsibilities, 91, 177
in Section 317 reauthorization, 214, 226
special population studies, 147
in state immunization programs, 6, 33, 160–161, 163, 165, 196, 216–217
state match requirements, 212–213
See also Section 317 program
Chicago, Illinois, 27, 30, 35, 67, 69
Child care centers, 133
Client-held medical records, 138
Clinical Assessment Software Application, 110, 113–114, 115, 157, 191 n.5
Clinics, public health, 8, 129–130
client trends, 166
educational intervention in, 137
historical role in immunization, 40, 142–143
immunization costs billed to client insurance carrier by, 94– 95
limitations on free vaccination in, 97–98
referrals from managed care settings to, 62–63, 129–130, 166–168
role of, 40–41, 62, 99–100, 166
Section 317 spending by local health departments, 153
Clinton administration, 35, 117
College student immunizations, 55, 106
Community Health Network, 113
Community/Migrant Health Centers grants, 196
Congressional action, 176–177
recommendations for, 2, 195, 224, 225–226
Connecticut, 201
Cost of vaccine delivery components, 21–24, 41, 42, 71, 100 n.1
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to disadvantaged populations, 216
to final 10 percent of population, 47–50
full immunization, 94
local determinants of, 50
Medicaid coverage, 64, 78
Medicare reimbursement, 24, 86–87
obstacles to monitoring, 24–25, 122, 148
reimbursement issues, 63
VFC spending, 78
Cost of vaccines
client out-of-pocket costs as barrier to immunization, 129– 130
determinants of, 100 n.1
full immunization, 21, 57, 94
influenza, 21, 89, 205
Medicaid coverage, 78
pneumococcal, 21, 89, 205, 227 n.4
public-sector discount, 21
trends, 57, 92
Council of State and Territorial Epidemiologists, 107
Coverage levels 1996 goals, 165
access to services as factor in, 133
accomplishments of national immunization program, 66
accountability issues, 150, 151
adult immunization, 4, 29, 69, 87, 217–220
among immigrant populations, 59–60
CDC pockets-of-need strategy, 178–180
challenges to improving, 4, 32, 146–148
client awareness intervention to improve, 136–138
cost determinants, 50
cost of achieving current levels, 19–29
current child levels, 19
current inadequacy, 3–4, 67–70
data sources, 110
disparities in adult vaccination, 69–70, 87, 218
disparities in childhood vaccination, 4, 29–31, 67–69
expanding access to services to improve, 129–133
extent of insurance coverage and, 74, 76–77, 144–146
focus on 2-year-olds, 19–21
goals, 1, 4
impact of budget reductions, 185
improving, 47
measurement methodologies, 110–115
in metropolitan areas, 4, 29–31
needs and performance measures, 17, 123, 146, 210, 226–227
NVAC recommendations to improve, 145
perceived acceptable levels, 108– 109
potential scope of federal programs, 81–83
private-sector immunization delivery and, 9, 151
as private-sector performance measure, 146
provider-based interventions to improve, 133–136
reducing client costs to improve, 129–130
risk of outbreaks, 3, 34–36
role of national immunization system, 6, 43–46, 47
role of registries in documenting, 116–117
role of registries in improving, 117
strategies to improve, 47, 128–129, 138–139, 151, 154
system-level interventions to improve, 139–140
variation by state, 60, 67
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D
Dallas County, Texas, 67
Delaware, 116
Development of new vaccines, 46–47
safety testing, 126
Diphtheria
surveillance, 107
vaccine, 55, 56, 66, 76–77
Disadvantaged populations, 177
cost of immunization, 216
disparities in coverage levels, 4, 29, 67–69
federal vaccine purchases for, 26, 38
health behavior, 216
monitoring coverage levels among, 63, 109, 113, 147
service delivery strategies, 178– 180
service delivery trends, 188–189
state responsibilities, 11
targeted service delivery, 47–50, 216–217
See also Pockets of need;
Vulnerable groups
Disease control and prevention component activities, 105–107
disease report investigations, 107– 108
government role, 65, 105–106
historical accomplishments, 18–19
impact of budget reductions, 183– 184
monitoring of disease reports, 107, 108
outbreak risk, 3, 34–36, 50, 108– 110
preventable mortality, 1, 4–5, 18, 29, 34, 35, 105
public health laboratory role, 107– 108
use of sentinels, 105
See also Monitoring of immunization status
District of Columbia, 27, 93, 96
Drug resistant organisms, 59
E
Educational interventions difficulties in, in current environment, 190
to increase community demand for vaccination, 136–137
by local health departments, 153– 154
private sector support for, 173
with providers, 135–136
Employee Retirement Income Security Act (ERISA), 75, 78, 101 nn.3–5, 145
Extra-immunization, 110
F
Federal aid to states for adult vaccination, 15, 205, 219
budgetary cycles, 16, 182, 203, 207
current spending, 26, 194–196
distribution among states, 208
finance practices, 177–183
grant reporting requirements, 16, 207
inadequacies in, 41–43, 142, 174, 187–188, 189
incentive grants, 91, 111, 177, 180, 208, 210–211
infrastructure support, 2, 9–10, 157–161, 176–178, 182, 189, 200, 207
instability in, 9–10, 32, 220–221
interaction of federal immunization efforts, 38
local health department operations, 152–153, 154–156
policy issues, 5–6, 33, 193
potential coverage of immunization programs, 81–83
purpose, 7–8, 11, 38–39, 175–176, 215
recommendations for formula approach, 2, 16–17, 208–215, 225–226
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recommendations for infrastructure support, 2, 15– 16, 224–225
for vaccine purchases, 8, 163, 177– 178, 194–196, 200–201, 205
See also specific program
Federal-state partnership
accomplishments of, 3, 34, 66
basis for, 7–8
federal role, 38–39
goals for, 2
historical development, 39–40
information collection and management, 108
for infrastructure support, 108, 188
lack of strategic plan for, 5, 10, 32–33
Florida, 201
Formula for federal grants
base grant, 208
incentive awards in, 210–211
methodology, 213–215, 216
population factors, 209, 216
rationale, 208
recommendations for, 2, 16–17, 225–226
state capacity and need considerations, 209–210
state match requirement, 16, 211– 213
G
Georgia, 199
Global population movement, 59
Goals
1996 immunization targets, 165
accomplishments of national immunization program, 66
adult immunization, 69, 217
coverage levels, 1, 4
difficulties in achieving coverage goals, 146–148
for federal-state partnership, 2, 38–39
financial resources for achieving, 142
full immunization schedule, 19– 21, 55
National Immunization Program, 91
national immunization system, 6, 41, 43–46, 103–104, 193–194
for primary care delivery of vaccination, 144
vaccination access, 206
vaccine purchase, 206
Guam, 27
H
Head Start, 153, 155, 202
Health Care Financing Administration, 8, 26, 64, 73, 146, 168, 202, 206
Health Insurance Association of America, 51
Health maintenance organizations, 62
implications for adult immunization, 219
quality assessment and improvement requirements, 146
Health Plan Employer Data and Information Set, 114, 115, 227
Health Resources and Services Administration, 175, 196
Healthy People 2000, 217, 218–219
Healthy People 2010, 144
Hepatitis A vaccine, 55, 56
Hepatitis B surveillance, 107
Hepatitis B vaccine, 15, 55, 76–77, 219
for adolescents, 57
cost, 57
Medicare coverage, 86
Medicare spending, 29, 86
Hold harmless provisions, 16, 225
Home visits, 132
Houston, Texas, 27, 30, 35, 67
Human immunodeficiency virus, 105
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I
Immunization Action Plan areas, 111, 178–179
Incentive awards, 111, 180, 208, 210– 211
for client or family, 138
Section 317, 91
for states, 177
Indian Health Service, 196
Indiana, 67
Influenza surveillance, 107
Influenza vaccine, 76–77
adult coverage levels, 4, 29, 66–67, 69, 87, 89, 217, 218–219
child coverage levels, 66
cost, 21, 89, 205
coverage goals, 144–145
current recommendations, 21, 55, 57, 89
Medicare spending, 8, 26–29, 86
preventable mortality, 69
private insurance coverage, 76–77
recommendations for purchasing, 2
standing orders for, 135
Information management
client-held medical records, 138
for disease control and prevention, 105–106, 108
disease report investigations, 107– 108
immunization registries, 116–122
in Medicaid, 63
in Medicare, 63, 87–89
monitoring of vaccine safety, 124– 128
in private sector, 63, 147–150
for public health infrastructure, 104–105
state efforts, 174–175
technical compatibility, 119
See also Monitoring of immunization status
Infrastructure, public health
components, 103–104
cost components, 21–24, 41
current instability, 1, 3, 204, 206– 207
definition, 104
effects of budget cutbacks, 168– 169, 173
evolution of immunization program in, 72, 143
federal responsibility, 11, 221–222
federal support, 9–10, 96, 157–161, 176–178, 185–186, 187, 202–203, 207
inadequate support for, 187, 188, 191 n.7, 207
information requirements for, 104–105
laboratories, 107–108
local health department roles, 152–156
nonfederal assistance to states, 203–204
private health care system and, 103, 143, 203–204, 206–207
recommendations for funding, 2, 15–16, 195, 207, 211–213, 224– 226
Section 317 grants for, 10, 91, 182– 183, 202–203, 207
state match requirements for funding, 2, 211–213, 226
state roles and responsibilities, 11, 140, 156–157, 222, 226
state spending, 161–163, 165, 173, 174, 175, 197–199, 202, 206–207
variation by state, 8–9, 50, 174, 199
See also Cost of vaccine delivery
Insurance, private
for adult vaccination, 72, 77, 87
capitated payments, 62, 63, 77, 83, 85, 147
immunization coverage, 15, 41, 62, 72, 74, 75, 76–77, 94, 144– 146, 191 nn.1–2
maintenance-of-effort requirements, 75–76, 76, 78
mandated coverage, 11–14, 74–76, 156, 205, 222–223
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role of, in national immunization program, 11, 14
state vaccine purchase and, 8
types of residual needs, 73
See also Uninsured and underinsured persons
International immunization programs, 90, 177, 183, 187
L
Laboratories, 107–108
Local conditions, 34, 47
cost of service delivery, 50
implications for expanding coverage, 165
responsiveness of immunization system, 221
Local health departments
federal funding, 154–156
relations with state health departments, 155
roles and responsibilities, 153– 154, 199
structure and operations, 152–153
Los Angeles, California, 35, 67
Louisiana, 218
Lyme disease treatment costs, 107
M
Maine, 51
Managed care, 34, 64
immunization data management, 25, 62, 114–115, 147–150
immunization service delivery, 62, 77, 85, 146–147
implications for adult immunization, 219
implications for public health infrastructure, 206–207
Medicaid enrollment, 62, 64, 83– 85
Medicare enrollment, 87
NVAC recommendations for, 145
obstacles to expanding coverage in, 146–147, 149
referrals to public clinics from, 62–63, 166–168
in SCHIP, 83
state-mandated services, 83
Mariana Islands, 27
Marshall Islands, 27
Massachusetts, 67
Maternal and Child Health Services grants, 10, 90, 161, 199, 209, 226
Measles outbreaks, 3, 34, 35–36, 106, 109, 133
Measles surveillance, 107
Measles, mumps, rubella vaccine, 55, 66, 70
insurance coverage, 76–77
safety concerns, 125–126
Medicaid, 9, 17, 26, 35, 37, 38, 63, 72, 74, 106, 109, 145, 160, 197, 199, 226
barriers to immunization access, 99–100
eligibility, 85, 156
enrollment, 77, 85, 94
funds for infrastructure support, 161, 196
immunization benefits, 41, 77–78
immunization spending, 26, 78
managed care enrollment, 62, 64, 83–85, 206
monitoring of immunization coverage in, 13, 63, 113, 187– 188, 210
obstacles to monitoring coverage in, 147, 149
outcomes and performance assessments, 146
potential participation, 81–83
residual need, 73, 211
state management, 50, 85, 146, 156, 163–164, 185, 200–201, 209–210, 213
Vaccines for Children program and, 64, 78–79, 97, 150, 221
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Medicare, 26, 63, 72, 74, 106, 188
adult vaccination coverage, 8, 26– 29, 194–196, 217, 219
immunization benefits, 86, 87, 89
information management, 87–89
managed care enrollment, 87
NVAC recommendations for, 145
vaccine reimbursement policy, 86–87, 102 n.23
vaccine spending, 24, 26–29
Meningitis surveillance, 107
Meningococcal vaccine, 55, 106
Metropolitan areas
disparities in vaccination coverage levels, 67, 69
federal funding to, 152–153
Immunization Action Plans for, 178–179
monitoring coverage in, 148
recent measles epidemic, 35
vaccination coverage, 4, 29–31, 34
Michigan, 42, 117, 148, 201
Micronesia, 27
Migrant populations, 59–60, 94
Military personnel, 196
Monitoring of immunization status among disadvantaged populations , 63
challenges in, 60, 63, 122
client awareness intervention, 136
consistent and comparable measures for, 17, 123, 195, 226– 227
cost of records management, 24– 25, 122, 148
critical areas, 122–123
current inadequacies, 5, 32, 150– 151, 187–188
effects of local conditions, 47
future challenges in, 66
in high-coverage areas, 122
historical development, 108–109
identifying geographic pockets of need, 110
impact of budget reductions, 184, 190
importance of, 50, 124
in local health departments, 154– 155
measures for use in, 17
in Medicare managed care, 87–89
methodologies, 110–115, 123
private-sector immunization delivery and, 9, 14, 25, 63, 147– 148, 151–152, 189, 223
problems in data management, 63, 64, 119–122, 123, 139
rationale, 11, 122, 139, 222
recommendations for improving, 2, 17, 195, 226–227
small-area studies, 109–110, 112– 113, 123, 148
state efforts, 157, 160, 169, 174– 175, 190
state responsibilities, 156
surrogate measures, 110
tools for, 47
use of registries in, 116–117, 119
Monitoring of vaccine safety, 124–128
Mortality/morbidity
disease trends, 18, 105
preventable infectious disease, 3, 4–5, 18, 29, 69–70, 105, 219
recent measles outbreaks, 3, 34, 35, 106
N
National Association of City and County Health Officers, 51, 153, 155
National Association of WIC Directors, 51
National Committee for Quality Assurance, 114
National Conference of State Legislatures, 51
National Governors’ Association, 51
National Immunization Survey, 110, 111–112, 184, 227
National immunization system accomplishments of, 3, 18–19, 34, 54, 66–67
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ambiguities in leadership and administration, 65–66, 143, 174
complexity of, 47–50, 54, 61, 65–66
current inadequacy, 3–5, 10–14, 29–33, 34–36, 54
dynamic nature, 43
federal role, 11, 34, 36–37, 38–39, 64, 65, 174, 175–177, 215, 221, 222
fundamental roles, 6, 43–46, 47, 103–104, 193–194
future challenges, 60–61
historical development, 39–43, 54
impact of budget reductions, 183– 185
infrastructure efforts in, 103–104
instability of, 1, 3, 10, 220–221
institutional relationships, 64, 65– 66
need for comprehensive strategy, 10–11, 32–33, 221
policy issues, 5–6, 33, 193
private sector role, 11–14, 34, 64, 143, 144, 174
public agencies and organizations in, 64, 175
state role, 11, 34, 64, 65, 174, 221, 222
National Notifiable Disease Surveillance System, 107
National Vaccine Advisory Committee, 31, 145, 150, 179
purpose, 35
National Vaccine Injury Compensation Program, 126– 128, 196
Native American, 37, 78
Nevada, 218
New Jersey, 50, 67, 85, 218
see also Newark
New York, 21, 27, 151, 218
Newark, New Jersey, 67, 148
North Carolina, 51
NVAC. See National Vaccine Advisory Committee
O
Outbreak risk, 3, 34–36, 50
clinical conceptualization, 108– 109
pockets of need and, 109–110
P
Pennsylvania, 201
Pertussis
surveillance, 107
vaccine, 56, 66, 76–77
Pneumococcal vaccine, 17 n.2
cost, 21, 89, 205, 227 n.4
coverage goals, 144–145
coverage levels, 4, 29, 69, 86, 217– 218
Medicare spending, 8, 26–29, 86
pediatric, 57
preventable mortality, 69
recommendations for adults, 21, 55, 89
recommendations for purchasing, 2
standing orders for, 135
Pockets of need, 4
federal infrastructure investments in immunization of, 176–177, 178–180
obstacles to identifying, 60
outbreak risk and, 109–110, 119
surveillance methods, 110
VFC effectiveness in, 37
See also Vulnerable groups
Polio, 18, 56, 66
surveillance, 107
worldwide eradication efforts, 177, 183, 187
Population movement, 59–60
Prevention. See Disease control and prevention
Primary health care
delivery of immunizations in, 62, 72, 223
goals for immunization delivery in, 37, 144
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monitoring of coverage levels in, 189
preventive services in, 189
Private health care system
accountability for immunization coverage, 146, 150
adult vaccination coverage in, 144–145, 188
contributions to state infrastructure, 203–204
cost of vaccines, 21
federal action in, 177
immunization data management, 114–115, 149–150
interaction with federal immunization efforts, 38, 62– 63, 64
mandated coverage, 222–223
monitoring of immunization status, 9, 14, 17, 63, 147–148, 149–150, 151–152, 189, 223
in national immunization program, 11–14, 34, 40–41, 43, 143, 144, 150, 174, 222
NVAC recommendations for, 145, 150
opportunities for improving coverage in, 152
public health infrastructure and, 103, 206–207
public health partnership, 151
quality assessment and improvement programs, 146, 189
referrals to public vaccination programs from, 129–130
service delivery in, 8, 61–63, 72, 129–130, 166, 188, 189, 200
state management and oversight of, 157–160, 177
See also Insurance, private;
Managed care
Public awareness and understanding of immunization status, 136
obstacles to, in current environment, 190
safety of vaccines, 128
Public Health Service block grants, 161, 196
Puerto Rico, 27
Q
Quality assessment and improvement, 146
R
Race/ethnicity
disparities in adult vaccination coverage, 4, 69–70, 87, 218
disparities in child vaccination coverage, 67
Registries of immunization, 157, 204
barriers to development and implementation, 119–122, 124
benefits, 119, 123–124
compatibility issues, 117, 119–122
definition, 116
efforts to date, 116–117, 123
fully functional, 141 n.6
funding for, 184
ideal components, 117
national system, 117
provider participation, 117
role in improving coverage levels, 119
Reminder-recall intervention
client, 136, 139, 154, 179
provider, 134
Reminder-recall-outreach intervention, 151
Residual needs, 94
determinants of, 99–100
examples of, 73
federal funding for, 15, 224
future challenges, 98–99, 205–206
state responses, 11, 100, 164–165
See also Disadvantaged populations;
Pockets of need;
Uninsured and underinsured persons;
Vulnerable groups
Rhode Island, 67
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Rotavirus vaccine, 56, 125, 201
Rubella infection, 107.
See also Measles, mumps, rubella vaccine
S
Safety of vaccines, 47, 177
adverse events, 60, 124–125, 126, 127, 141 n.11
monitoring, 124–128
public awareness and understanding, 128
San Antonio, Texas, 27
San Diego, California, 51
Schedule of vaccinations, 46–47
changes in, implications for service delivery, 14–15, 60–61, 66, 190, 195, 223–224
concerns of universal purchase states, 98
current, 21, 55
delay between vaccine approval and availability, 60, 79, 100
provider reminder-recall, 134
rate of change in, 55, 57
recent changes in, 55–57
state requirements, 137, 145–146
SCHIP. See State Children’s Health Insurance Program
School-based immunization, 112, 132– 133, 156
Section 317 program, 112, 152, 188– 189, 194
accomplishments of, 8
administrative problems for states, 203
adult vaccination funding, 90, 219
budget cutbacks, 168–169, 176, 177–178, 182–183, 190, 203
carryover of funds, 51, 180–183, 203
current funding mechanism, 27– 28, 90
formula funding mechanism, 2, 16–17, 195, 208–215, 216, 225– 226
historical development, 89–90
immunization coverage under, 90–91
incentive awards, 91, 210–211
infrastructure grants, 2, 10, 90, 91, 157–161, 165, 176, 177–178, 182–183, 185–187, 187, 200, 202–203, 207
interaction of federal immunization efforts, 38, 97, 99
level of funding for, 90, 185
local health department funding, 153
outbreak control funding, 183–184
pockets-of-need strategy, 178–180
policy issues, 5–6, 33, 193
program operations, 90, 185–186
provisions, 17 n.1
purpose, 26, 36–37, 43, 72, 89–90, 91–92, 176, 199, 209
reauthorization, 214, 226
recommended funding for, 2, 14, 15, 195, 207, 224
resource allocation, 38, 91, 165, 177–178, 185–187, 200, 202
SCHIP and, 38, 51, 196
special population studies under, 147
state match requirements, 9, 212
vaccine purchases, 8, 61, 90–91, 95, 177–178, 200, 201, 223–224
VFC program and, 38, 90
Section program, 2, 5
Settings for immunization comparisons of coverage, 110
current distribution, 61–62
dispersion of responsibilities, 64
historical evolution, 39–41
implications for monitoring coverage, 63, 64, 122
nonmedical, 131–133
primary care provider, 62
private sector, 61–63, 188
service delivery trends, 8, 188
strategies for expanding access, 130–131
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Small-area immunization studies, 109– 110, 112–113, 123, 148
Smallpox, 18, 57–59
Social benefits of immunization, 71
Social service programs
access to immunization in, 131– 132
identifying underimmunized populations through, 35
linkage with immunization program, 32, 41, 154, 155
state infrastructure funding from, 161
Socioeconomic status
disparities in vaccination coverage levels, 4, 29, 67, 129
obstacles to improving coverage disparity, 32
trends, 166
utilization of public clinics, 129– 130
Standing orders, 135
State Children’s Health Insurance Program (SCHIP), 9, 17, 26, 41, 74, 143, 145, 149, 154, 160, 206
capitated insurance programs and, 83, 85
coordination with other vaccine programs, 185, 211
coverage policies, 83, 101–102 n.17
enrollment trends, 62
grant allocation, 79
interaction of federal immunization efforts, 38, 83
managed care arrangements, 83
monitoring of immunization coverage in, 187–188, 210
performance monitoring, 109
policy issues, 5
potential participation, 81–83
public health infrastructure support in, 196
purpose, 38, 79, 106, 196
residual need, 72, 73, 94, 211
Section 317 and, 38, 51, 196
state administrative practices, 79– 81, 85, 146, 156, 180, 209–210, 213
Vaccines for Children program and, 166, 202, 221
State immunization programs
administration of local health departments, 153
adult vaccination, 224
allocation of federal funds among, 208
core functions, 43, 160–161
current inadequacy, 1, 32, 174
current obstacles to service delivery, 189–190
efficient use of federal funds, 210– 211
eligibility for free vaccines in, 97– 98
federal infrastructure grants, 9– 10, 13
federal role in, 7–8, 175–176
finance practices, 163–168, 182
future prospects, 1, 190–191
impact of budget reductions, 183– 185
infrastructure problems, 204
infrastructure spending by, 2, 8–9, 29, 50, 161–163, 174, 175, 197– 199
linkage with other service programs, 32
Medicaid administration, 78, 146
policy issues, 5–6, 33, 193
private-sector management and oversight, 157–160
quality assessment and improvement programs, 146
recommendations for adult vaccine spending, 2, 15, 195, 224
recommendations for infrastructure funding, 2, 15– 16, 195, 207, 224–225
recommendations for monitoring, 2
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recommendations for Section 317 funding mechanism, 2, 16–17, 208–215, 225–226
required vaccination, 137, 145–146
requirements for private insurance coverage, 74–75
requirements for private-sector data management, 149
resource allocation, 100, 157–161, 163–164, 165–166, 169, 173, 180, 197–199, 200–201
response to budget reductions, 9– 10, 168–169, 173, 174, 180, 189, 203
response to residual needs, 11, 100, 164–165
roles and responsibilities, 7, 156– 157
SCHIP administration, 79–81
Section 317 grants, 90, 91–92, 157– 161, 165, 182–183, 185–187, 199, 203
vaccine purchases, 2, 8, 10, 29, 61, 91–95, 163, 196–199, 200–201, 205
variation by state, 8–9, 49–50, 60, 67, 93–95, 164–165, 174, 199
VFC provisions, 78–79, 95–97, 166
T
Task Force on Community Preventive Services (TFCPS), 128–129, 130–131, 132, 133, 134, 135–136, 137, 138, 139
Temporary Assistance for Needy Families, 161
Tetanus surveillance, 107
Tetanus vaccination, 15, 55, 56, 66, 76– 77
adult booster, 219
Texas, 67
See also Dallas County, Houston
Thimerosal, 125
Title V grants, 196
Tuberculosis, 59
U
Uninsured and underinsured persons
current estimates of, 74, 77, 94
high-risk adults, 87
private health care enrollment, 94
recommendations for funding, 15
residual need, 94
SCHIP for, 38
vaccine delivery, 8
VFC program for, 37, 78, 95, 96
Universal purchase programs, 8, 72, 97, 201, 202
cost of additions to immunization schedule, 98
Utah, 201
V
Vaccine Adverse Events Reporting System, 126
Vaccine purchases
current inadequacies, 1, 205–206
federal programs, 36, 37, 61, 64, 187
federal spending, 8, 26–29, 194– 196, 205
projected needs, 14–15, 195, 223– 224
recommended federal funding for, 14, 15, 195, 224
role of national immunization system, 6, 43
under Section 317, 90–91, 177–178, 200, 201
Section 317 savings for states, 200
state immunization programs, 163
state spending, 8, 10, 29, 61, 91– 97, 196–199, 200–201, 205
under VFC program, 78, 81, 187, 223–224
See also Cost of vaccines
Vaccines for Children (VFC) program, 8, 9, 26, 36, 64, 72, 74, 92, 129, 145, 154, 160, 166, 188–189, 194
accomplishments, 37
OCR for page 308
Calling the Shots: Immunization Finance Policies and Practices
administrative costs, 201–202
coverage policies, 78, 83, 95, 101 nn.10–11, 221
enhanced programs, 96
future challenges, 98–99
health care provider enrollment, 63, 78
increases in coverage associated with, 130
interaction with other vaccination programs, 38, 83, 97, 166, 185
limitations, 37, 43, 85, 180
Medicaid and, 64, 78, 79, 97, 150, 166, 200, 221
monitoring of immunization coverage in, 187–188
performance monitoring, 109
potential participation, 81–83
prior to, 92
provider participation, 64
purpose, 37, 43, 72, 78, 161
recommended federal funding, 14, 223–224
referrals, 129–130
requirements for states, 78–79
residual need, 73, 94, 98–99
resource management by states, 161, 163–164
role of public health agencies in, 143
SCHIP and, 166, 202, 221
Section 317 program and, 38, 89
vaccine purchase savings for states, 93, 97, 200
vaccine purchases, 26, 61, 78, 93, 95, 223–224
Varicella vaccine, 55, 56, 77, 79
cost, 57
coverage rate, 60
delays in availability, 60, 79, 100
Vermont, 67
VFC. See Vaccines for Children program
Virgin Islands, 27
Vulnerable groups, 33
monitoring coverage in private sector, 9, 63, 147, 149–150, 151, 152
monitoring needs, 66, 151
service delivery trends, 188–189
state role in monitoring, 11
surveillance methods, 112–113
trends, 66
See also Disadvantaged populations;
Pockets of need
W
Washington, 111–112, 201
West Nile-like virus, 59
Women, Infants, and Children (WIC) program, 10, 32, 35, 41, 64, 131–132, 138, 153, 154, 155, 157, 161, 199, 202
in CDC interventions in low-coverage areas, 179–180
Representative terms from entire chapter:
adult vaccination
