Calling the Shots examines the basic strategies that finance the national immunization system in the current health care climate. It is a comprehensive volume, rich with data and highlighted examples, that explores:

• The evolution of the system in light of changing U.S. demographics, development of new vaccines, and other factors.
• The effectiveness of public health and health insurance strategies, with special emphasis on the performance of the "Section 317" program .
• The condition of the infrastructure for control and prevention of infectious disease, surveillance of vaccines rates and safety, and efforts to sustain high coverage.

Calling the Shots will be an indispensable resource to those responsible for maintaining our nation's vaccine vigilance.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON IMMUNIZATION FINANCE POLICIES AND PRACTICES
• INDEPENDENT REPORT REVIEWERS
• Preface
• Executive Summary
• 1. Introduction
  • BACKGROUND
  • CHARGE TO THE COMMITTEE
  • STUDY CONTEXT: THE NATIONAL IMMUNIZATION PARTNERSHIP
  • SIX ROLES OF THE NATIONAL IMMUNIZATION SYSTEM
  • STUDY APPROACH
  • ORGANIZATION OF THE REPORT
• 2. Change and Complexity in the National Immunization System
  • KEY CHANGES
  • INCREASING COMPLEXITY
  • SUCCESSES AND PERSISTENT PROBLEMS
• 3. Financing Vaccine Purchase and Delivery
  • PRIVATE INSURANCE COVERAGE OF IMMUNIZATION
  • MEDICAID, VACCINES FOR CHILDREN, AND STATE CHILDREN'S HEALTH INSURANCE PROGRAM
  • MEDICARE
  • SECTION 317 VACCINE PURCHASE GRANTS
  • STATE VACCINE PURCHASE
  • ISSUES IN VACCINE PURCHASE
  • SUMMING UP
• 4. Building, Monitoring, and Sustaining Immunization Capacity
  • INFECTIOUS DISEASE PREVENTION AND CONTROL
  • SURVEILLANCE OF VACCINE COVERAGE AND SAFETY
  • EFFORTS TO IMPROVE AND SUSTAIN HIGH VACCINE COVERAGE RATES
  • SUMMING UP
• 5. Immunization Finance Policies and Practices
  • PRIVATE-SECTOR ROLES AND RESPONSIBILITIES
  • LOCAL HEALTH DEPARTMENT ROLES AND RESPONSIBILITIES
  • STATE ROLES AND RESPONSIBILITIES
  • FEDERAL ROLES AND RESPONSIBILITIES
  • SUMMING UP
• 6. Summary Findings, Conclusions, and Recommendations
  • SIX QUESTIONS AND SIX ANSWERS
  • CONCLUSIONS
  • SUMMARY RECOMMENDATIONS
• References
• Appendixes
  • Appendix A Public Health Services Act, Section 317
  • Appendix B Immunization Time-Line
  • Appendix C List of Contributors
  • Appendix D Overview of State Survey
  • Appendix E Overview of Case Studies and Site Visits
  • Appendix F Annual Section 317 Awards to States, 1995–1999
  • Appendix G State Immunization Requirements for School Children
  • Appendix H Committee and Staff Biographies

Support for this project was provided by the Centers for Disease Control and Prevention (Award No. 200199900023). The views presented are those of the Institute of Medicine's Committee on Immunization Finance Policies and Practices and are not necessarily those of the funding organization.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.