WASHINGTON, D.C. - The recent decrease in federal immunization spending may mean that fewer children will be fully vaccinated.
"State health officials believe that federal funding must be restored, because the recent cuts are putting children at risk," said Claire Hannan, director of immunization policy, Association of State and Territorial Health Officials (ASTHO). ASTHO represents the senior executive officer of the departments of health in the states, territories and the District of Columbia.
The good news is that the immunization infrastructure - state, local and federal government efforts to plan, carryout and evaluate the delivery of vaccines - is largely in place after years of planning and hard work. Examples of infrastructure activities include: registry development, education and outreach materials, coalition building, reminder/recall systems and linking with the Women, Infants and Children's program (WIC) and Temporary Assistance for Needy Families (TANF) and communities.
The bad news is that the funding to continue supporting these programs is decreasing, which could result in a failure to meet the 90% immunization coverage goal for 2000.
"While there is no evidence to prove that increased investment has resulted in increased coverage rates, there is no evidence to suggest it hasn't," Hannan said at a recent meeting sponsored by Every Child By Two. "Can we really afford to cut investment in vaccine delivery systems before we have all the facts."
The problem with children missing immunizations is that they become susceptible, and an increase in the pool of susceptible children increases the likelihood for outbreaks of disease. State health officials said they do not want to wait until another outbreak occurs to have evidence that the current decreased funding has resulted in lower coverage rates, she added.
The federal budget cuts are being felt in every aspect of the infrastructure programs, including cancellations of contracts with WIC and TANF and severe reductions in registry development and maintenance, Hannan reported. Unless the federal budget is restored in a timely manner, state health officials fear that reductions in staff, clinic hours and delivery of immunizations will hinder their ability to protect children from disease.
State officials are not the only ones worried about the budget cuts. The Centers for Disease Control and Prevention (CDC) has also expressed concern over the slash in FY99 funding. There have been decreases in financial assistance (FA) grants for operational activities.
"It is obvious that the federal commitment for funding a substantial proportion of immunization program activities is diminishing, and the paradigm for funding immunization programs will need to change also," said William P. Nichols, associate director for management and operations at the National Immunization Program, CDC. "We will need to work together to access any available funds if we are to sustain the achievements we all have worked so hard to realize. It won't be easy to ensure the systems that have been created do not get torn down as a result of insufficient funding."
For 1998, $195 million in 317 FA funds were awarded compared with $281 million in FA funds in 1997.
To help solve the budget crunch, the CDC has been working with the 317 grantees to reduce carryover balances by awarding carryover funds to those states with large carryover balances in lieu of their receiving new funds, and then distributing the new funds to those states with little or no carryover. How ever, Nichols said, now there is insufficient carryover to compensate for more than $86 million in operational appropriations reductions that have taken place over the past five years.
The FY1999 budget appropriation combined with a small amount of remaining carryover total only $130 million. "This will result in a 33% reduction in available funds between 1998 and 1999," he added.
Because of the decrease in funding, priorities for spending had to be set. Registry funding for 1998 was limited to the costs of maintaining, but not expanding, these information systems. Funds had to be directed to strategies known to be immediately effective in raising and sustaining immunization coverage levels and preventing disease.
FY 99 317 program award to states will support as much of the core immunization program functions as available funds will allow.
"It is imperative that we explore the possibility of obtaining additional re sources through other sources. Grantees (states, territories and several major cities) will need to look within their areas to find funds to maintain the systems they have created," Nichols said.
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