Objective
Following an outbreak of measles in 1989-1991, a blueprint for change
was developed to improve immunization coverage by addressing deficiencies
in the immunization delivery system. A review was undertaken by the National
Vaccine Advisory Committee (NVAC) to assess progress in improving immunization
coverage, decreasing disease incidence, and developing an immunization delivery
system to serve children in the United States. Based on this review, strategies
were recommended to sustain success in immunization coverage.
Participants
A Subcommittee on Immunization Coverage was appointed by the chairman
of the NVAC in 1995 and included representatives from federal agencies, professional
organizations, vaccine manufacturers, state and regional health departments,
and academic centers.
Evidence
Presentations on immunization programs, strategies, and financing were
made to the subcommittee by representatives from federal, state, and local
agencies; professional organizations; insurers; businesses; and public and
private health care providers. Evidence from the published literature also
was reviewed.
Consensus Process
After review and discussion of evidence presented, conclusions and recommendations
were crafted and endorsed by members of the subcommittee. The subcommittee's
report was submitted to the NVAC for review, comment, and approval.
Conclusions
Although incidence rates of traditional vaccine-preventable diseases
are at all-time low levels and corresponding vaccination coverage rates are
at all-time high levels, a system to ensure timely vaccination of the 11,000
US infants born each day that also incorporates newly recommended vaccines
is incomplete. Key barriers include lack of financing of vaccination in many
insurance programs and the lack of implementation of evidence-based interventions
to raise coverage levels. The NVAC makes 15 recommendations to achieve a sustainable
childhood immunization delivery system organized around (1) vaccination financing
to ensure full insurance coverage of recommended vaccines and to support the
Vaccines for Children program; (2) provider practices to ensure the implementation
of recall/reminder systems and office-based assessment of coverage levels;
(3) information systems for monitoring disease, vaccination coverage, and
performance on immunization delivery; and (4) support for communities and
families to ensure that the public is aware of the importance of vaccination,
that resources are focused to help underserved children, that immunization
linkages with WIC (the Special Supplemental Nutrition Program for Women, Infants,
and Children) are enhanced, and that citizen coalitions can advocate improvements
in the immunization delivery system.