Calling the Shots Immunization Finance Policies and Practices (2000) / Chapter Skim
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Executive Summary
Executive Summary
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immunization system. Many states have reduced the scale of their immunization programs and currently lack adequate strength in areas such as data collection among at-risk populations, strategic planning, program coordination, and assessment of immunization status in communities that are served by multiple health care providers.
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The goal of this renewed partnership is to prevent infectious disease; to monitor, sustain, and improve vaccine coverage rates for child and adult populations within more numerous and increasingly diversified health care settings; and to respond to vaccine safety concerns. To achieve this renewal, states require a consistent strategy, additional funds, and a multiyear finance plan that can help expedite the delivery of new vaccines; strengthen the immunization assessment, assurance, and policy development functions in each state; and adapt childhood immunization programs to serve the needs of new age groups (especially adults with chronic diseases)
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, and · recent reductions in federal immunization grants to the states (reflecting congressional responses to shifting health care roles and responsibilities within the federal government, the states, and private health care providers) , which followed on the heels of dramatic increases in the early l990s.
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The immunization system has successfully reduced racial and ethnic disparities in childhood immunization levels, but coverage levels in areas of concentrated poverty remain significantly lower than national and statewide levels. National surveys reveal a gap of 9 percentage points between children above and below the federal poverty level for the complete series of the most critical childhood vaccines.
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3. What are current and future funding requirements for immunization activities, and how can those requirements be met through a combination of state funding, federal Section 317 immunization grant funding, and funding available through the State Children's Health Insurance Program (SCHIP)
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· Control and prevent infectious disease. · Conduct populationwide surveillance of immunization coverage levels, including the identification of significant disparities, gaps, and vaccine safety concerns.
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Each state currently invests in immunization programs through direct or in-kind support, but no state has sufficient resources to support all six of the above immunization roles. Consequently, federal assistance is required to help each state maintain the essential elements of an immunization pro
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Vaccine Purchase. Federal assistance for state vaccine purchases and immunization programs is provided primarily through two funding streams: Section 317 of the Public Health Service Act, administered by the National Immunization Program within CDC, and the Vaccines for Children (VFC)
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Individual health care providers and health plans have traditionally not been expected to monitor patterns of vaccine coverage or disease within their communities, nor are they currently equipped to assess coverage levels in formats that can facilitate long-term populationwide studies or analysis of local or statewide health patterns. IMMUNIZATION FINANCE POLICIES AND PRACTICES Federal funding for state immunization programs underwent a major and rapid rise in response to the 1989-1991 measles epidemic: there was a more than seven-fold increase from $37 million in 1990 to $261 million in 1995.
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This instability now erodes the continued success of immunization activities. The instability of funding for state immunization programs discourages the development of strategic responses designed to foster disease prevention, improve immunization coverage levels for specific populations and age groups, reduce coverage disparities between low-income groups and the general population, and ensure vaccine safety.
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Performance monitoring, including the development of immunization registries, is important to assure that vulnerable groups have access to adequate primary health care and that public resources are used efficiently in meeting residual needs where necessary. Conclusion 4: Private health care plans and providers have the capacity to do more in implementing immunization surveillance and preventive programs within their health practices, but such efforts require additional assistance, oversight, and incentives.
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is sufficient to meet state requests for child vaccines within the immunization schedule recommended by ACIP as of January 2000.2 But additions to the ACIP schedule will expand the burden of preventive health care costs to state and federal health agencies as well as private health plans. Congress should anticipate such cost increases by requiring that CDC notify Congress each year of two trends: (1)
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Recommendation 3: State immunization infrastructure programs require increased financial and administrative support to strengthen immunization capacity and reduce disparities in child and adult coverage rates. The committee recommends that states increase their immunization budgets by adding $100 million over current spending levels, supplemented by an annual federal budget of $200 million to support state infrastructure efforts.
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The additional state contribution of $100 million per year above current spending levels is necessary to reduce current disparities in state spending practices and to address future infrastructure needs in such areas as records management, development of appropriate performance measures and immunization registries, and outreach and education for adult vaccines. Federal reporting requirements for immunization grants should be reduced to six key areas that reflect the six fundamental roles of the national immunization system discussed in this report.
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Such measures can also facilitate efforts by state and federal health officials to assess the quality of primary-care health services within private-sector health plans, so that public health agencies can direct appropriate resources to areas in which private-sector plans do not have sufficient capacity to meet health care needs. The use of consistent immunization measures offers benefit not only for immunization efforts, but also for other national programs that require national investments in primary health care.
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