Calling the shots: Immunization finance policies and practices - Executivesummary of the report of the Institute of Medicine

Federal, state, and private-sector investments in vaccine purchases and imm unization programs are lagging behind emerging opportunities to reduce the risks of vaccine-preventable disease. Although federal assistance to the st ates for immunization programs and data collection efforts rapidly expanded in the early part of the 1990s, significant cutbacks have occurred in the last 5 years that have reduced the size of state grant awards by more tl-la n 50% from their highest point. During this same period, the vaccine delive ry system for children and adults has become more complex and fragmented. This combination of new challenges and reduced resources has led to instabi lity in the public health infrastructure that supports the U.S. immunizatio n system. Many states have reduced the scale of their immunization programs and currently lack adequate strength in areas such as data collection amon g at-risk populations, strategic planning, program coordination, and assess ment of immunization status in communities that are sen ed by multiple heal th care providers. If unmet immunization needs are not identified and addre ssed, states will have difficulty in achieving the national goal of 90% cov erage by the year 2010 for completion of the childhood immunization series for young children. Furthermore, state and national coverage rates, which r eached record levels for vaccines in widespread use (79%, 1998), can be exp ected to decline and preventable disease outbreaks map occur as a result, p articularly among persons who are vulnerable to vaccine-preventabIe disease because of their underimmunization status. The Institute of Medicine (IOM) Committee on Immunization Finance Policies and Practices has therefore concluded that a renewal and strengthening of t he federal, and state immunization partnership is necessary. The goal of th is renewed partnership is to prevent infectious disease; to monitor, sustai n, and improve vaccine coverage rates for child and adult populations withi n more numerous and increasingly diversified health care settings; and to r espond 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) in different health care environ ments. The IOM committee recommends that federal and state governments adopt a nat ional finance strategy that would allocate $1.5 billion in federal and stat e resources over the first 5 pars to strengthen the infrastructure for chil d and adult immunization-an annual increase of $175 million over current sp ending levels. These resources would consist of $200 million per year in st ate infrastructure grants awarded by the Centers for Disease Control and Pr evention (the Section 317 program) and an additional $100 million per year in increased state contributions. The committee also recommends that the Co ngress replace the current discretionary Section 317 grants with a formula approach for state immunization grant awards to improve the targeting and s tability of federal immunization grants. The formula should provide a base level of support to all states, as well as additional amounts related to ea ch state's need, capacity, and performance. The committee further recommend s that Congress introduce a state match requirement for the receipt of incr eased federal funds to help strengthen and stabilize the infrastructure tha t supports long-term public health assessment, assurance, and policy develo pment efforts. Along with the development of a strategic investment plan to support immuni zation infrastructure, the committee recommends that the federal government provide $50 million in additional funds to help states purchase pneumococc al and influenza vaccines for adults aged <65 who are not eligible for othe r forms of public health insurance and who have chronic illnesses such as h eart and lung disease or diabetes. The committee further recommends that st ates increase their own vaccine purchases by $11 million annually for adult s who cannot afford vaccines but who are not eligible for federal assistanc e (i.e., the "underinsured"). Finally, the committee recommends that federa l and state agencies develop a set of consistent and comparable measures to monitor the status of children and adults enrolled in public and private h ealth plans.