July 2000
WASHINGTON, D.C. - A joint study by the Centers for Disease Control and Prevention (CDC) and the Institute of Medicine (IOM) of the National Academies found the country's immunization system ill-equipped to meet future financial needs. An IOM committee recommended federal and state governments allocate $1.5 billion over the next five years, a $175 million annual increase over current spending, to bolster infrastructure and boost public and private vaccination efforts.
Those resources would stem from $200 million per year in state infrastructure grants from the CDC's Section 317 state grant program and a $100 million per year increase in state contributions.
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The IOM committee recommended Congress replace Section 317 funding with a formula approach for state immunization grant awards and introduce state-matching requirements for increased federal funds.
For adults, the committee recommended the federal government provide an additional $50 million to states for pneumococcal and influenza vaccines. It is also recommended that states increase their own vaccine purchases by $11 million annually for those who can't afford vaccination but aren't eligible for federal assistance.
The committee also recommended federal and state agencies find measures to monitor children and adults enrolled in public and private health plans.
A current air of instability within the system stems from an era of accelerated vaccine research and production, increasingly complex health care services and a reduction in federal immunization grants to states.
Problems with the current immunization system include sustaining high coverage levels for a growing number of new vaccines; disparities in childhood levels of immunization coverage; low coverage rates and racial/ethnic disparities for adults; morbidity and mortality from preventable diseases; and gaps in coordination, support and documentation of immunization efforts.
Currently, state and local public health agencies are not adequately prepared to deliver new vaccines, to increase efforts to immunize adults with chronic health problems or to eliminate disparities between the low-income groups and the general public, according to the report.
David Smith, MD, a pediatrician and co-chair of the Committee on Immunization Finance Policies and Practices, and colleagues looked at 28 major metropolitan areas and performed county analyses. Data revealed the nation is at a record high immunization level of 79%. But with 11,000 children born each day, at the end of two years only 8,700 have been fully immunized, leaving 2,300 children vulnerable to vaccine-preventable diseases.
"Then you look at a major metropolitan area like Houston, which is only at 57%," said Smith, who is also president of the Texas Tech University Health Sciences Center in Lubbock, Texas.
"Subsets of our large metropolitan areas, such as Chicago, have levels of 29% to 53% of children being immunized. If somebody throws a match on this forest floor with all the dry kindling, we're going to have a bad forest fire. We have 300 children die each year from vaccine-preventable disease. One is too many."
"The key here is the infrastructure," said Smith. "The whole health care system is moving - health care reform, finance reform, new delivery models, contracting HMOs, PHOs, PPOs. Then, there are new vaccines. It's an unstable environment. Some component of the immunization system has to be predictable. You cannot have this ebb and flow of interest and federal funding. There has to be a stable commitment."
| Federal Immunization Funding, FY 1999 (Millions) | |||
|---|---|---|---|
| Program | Federal | State | Total |
| Section 317 | $448 | Unknown | $448 |
| Vaccines for Children | $467 | Not applicable | $467 |
| Medicaid | $70 | $57 | $127 |
| Medicare | $115 | Not applicable | $115 |
| Total | $1100 | $57 | $1157 |
| Source: CDC, 1999 | |||
For more information:
- Calling the Shots. Immunization Finance Policies and Practices. Institute of Medicine. To obtain a copy of the report, call (800) 624-6242 or (202) 334-3313, or visit www.nap.edu.
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