State-level perspectives on immunization policies, practices, and program financing in the 1990s

This article reports on a series of structured interviews with immunization program officials in all 50 states regarding the effects of changes in fed eral policies and funding in the 1990s on the goals, priorities, and activi ties of state immunization programs. The purchase of vaccines is a major component of ail state immunization pro grams. The Vaccines for Children (VFC) program, implemented in 1994, has be come the primary source of vaccine purchase support in almost all states. A concern of many state immunization programs is their ability to ensure tha t vaccines are available to children who are riot VFC: eligible. State immunization programs also are involved in a myriad of activities nec essary to ensure that children are adequately and appropriately immunized ( e.g., vaccine administration, outreach to parents). Federal funding to supp ort these activities increased significantly during the mid-1990s, but was substantially reduced beginning in 1997. Because of these funding decreases , most states had to reduce the scale and scc,pe of their immunization acti vities. State-level funding support for immunization programs varies, with state go vernments mole likert to support Vaccine purchase than immunization activit ies. Immunization will never be completed. Along with each new birth cohort, cha nges to the primary immunization schedule (i.e., addition of new vaccines a nd expansion of existing recommendations to encompass broader target groups ) create ongoing needs for vaccine purchase and other immunization activiti es. Longterm immunization planning must reflect these continually expanding needs.