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Calling the Shots: Immunization Finance Policies and Practices
emphasis has been on pediatric immunization, but use of Section 317 funds for adolescents and adults has been permitted since 1994. Section 317 currently supports 64 state, territorial, and municipal health agency immunization programs. These funds enable grantees to purchase vaccines and ensure that other basic functions of an immunization program are carried out.
The Section 317 program supports national-level and centrally operated CDC programs, as well as state grants. Under the category of program operations, CDC develops national goals, plans and assesses strategies for reaching these goals, negotiates consolidated vaccine purchase contracts, provides surveillance of vaccine-preventable diseases and technical assistance to state and local health agencies, and conducts vaccine safety activities. CDC also engages in international eradication efforts targeting polio, measles, and other vaccine-preventable diseases, which account for a growing share of Section 317 funding.
Section 317’s discretionary grants to states take two forms: (1) Direct Assistance (DA), which amounts to a line of credit with CDC for the purchase of vaccines as needed, salaries of federal public health personnel who work within state agencies, and support for immunization registries, and (2) Financial Assistance (FA), which the states may use for programmatic activities such as outreach, disease surveillance and outbreak control, professional and public education, and immunization assessment. Legislative history clearly reflects that the 317 program was intended to supplement state and local immunization efforts; grantees are specifically prohibited from using federal grant funds to replace existing state spending on immunization programs.
The level of funding for the Section 317 program is set through annual federal appropriations, and both the total appropriation and the distribution of awards among the states and local grantees are discretionary. The total appropriation is determined by Congress and the individual grant amounts by CDC. Unlike two other major state grant programs that focus on child health—the Maternal and Child Health Services Block Grant and SCHIP—Section 317 awards involve no federal formula and require no financial matching of federal grants with state funds.
Historically, CDC’s annual budget request for the Section 317 program has tracked the level of funds appropriated in the previous year. Although it is not an explicit program standard, by the early 1990s CDC had articulated Section 317’s programmatic responsibility as the financing of vaccines for roughly half of all children served in the public sector (Kelley et al., 1993). Those children dependent on the public sector for immunizations were estimated to comprise 25 to 30 percent of the national birth cohort, just slightly less than the fraction estimated for the initial polio vaccine program in the 1950s. States and localities were expected to