Setting the Course A Strategic Vision for Immunization: Part 3: Summary of the Los Angeles Workshop (2003) / Chapter Skim
Currently Skimming:
A National Perspective on the Immunization System
A National Perspective on the Immunization System
Pages 8-17
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From page 8... ...
, provided an overview of immunization issues facing the country, the findings and recommendations on immunization finance from the IOM study, and CDC's response to those recommendations.2 THE NATIONAL IMMUNIZATION PICTURE Immunization Coverage Over the course of the 20th century, the introduction of new vaccines and efforts to ensure that children are appropriately immunized produced substantial reductions in illness from many serious diseases (see Table 1~.
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. Although coverage rates for many individual vaccines approach and even exceed 90 percent, the various missed doses lower the rates for a complete immunization series.
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Immunization levels are also persistently lower among low-income children and adults. Although the annual NIS and other state-based immunization surveys provide estimates of general population immunization coverage levels, they frequently rely on telephone household surveys that do not include estimates for pockets of high-risk, underimmunized populations represented by groups such as public housing districts or neighborhoods characterized by deep poverty (U.S.
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Orenstein noted that the nation's immunization system is facing challenges that could undermine past achievements and hinder the effort still needed to reach targeted levels of immunization coverage. Some of these demands include sustaining current rates of coverage with the addition of new and more expensive vaccines to the immunization schedule, responding to concerns about the safety of vaccines, serving an increased number of people as a result of recommendations for expanded adolescent and adult vaccination, and adapting to changes in the health care delivery system that can affect the availability and affordability of vaccines in the private sector.
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Combination vaccine products help reduce the number of separate injections required, but the use of products with different combinations of vaccines can make it more difficult to manage the immunization requirements of children who receive immunizations from multiple providers. The high cost of newer vaccines, reflecting in part the increased costs of production and distribution, is having a marked impact on federal, state, and local budgets for vaccine purchase.
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In addition, CDC supports vaccine safety studies, including the work of an IOM committee that is reviewing several safety topics over a 3-year period and the Vaccine Safety Datalink project. To respond to other needs, CDC is also focusing attention on adult immunization, on the improvement of the surveillance and measurement tools used to monitor immunization, and on the implementation of evidence-based activities aimed at improving immunization rates.
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Furthermore, federal and state governments share responsibility for supporting vaccine purchase and the infrastructure essential for achieving and sustaining national immunization goals. Data reviewed
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In addition, a requirement for a state funding match should be added, and the federal grants should have a 2-year budget cycle to give states greater flexibility to plan and implement multiyear efforts. Finally, the IOM report recommended that federal and state agencies develop a set of consistent and comparable measures for use in monitoring the immunization status of children and adults enrolled in private and public health plans as well as the immunization status of populations in defined geographic areas.
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CDC is also encouraging states to enroll health care providers who treat adolescents in VFC so that they can obtain free VFC vaccine for eligible patients. The enrollment of more adolescents in State Child Health Insurance Programs is also seen as an opportunity to improve access to lower cost immunization services for this population.
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Toward this end, CDC is working with the National Committee for Quality Assurance to modify immunization measures in the Health Plan Employer Data and Information Set (HEDIS) to better reflect immunization recommendations.
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