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Consensus Statement
July 28, 1999

Strategies to Sustain Success in Childhood Immunizations

Author Affiliations

Author Affiliations:The National Vaccine Advisory Committee: Georges Peter, MD (Chair), Rhode Island Hospital, Providence, RI; Edgar K. Marcuse, MD* (Past Chair), Children's Hospital and Regional Medical Center, Seattle, Wash; Robert F. Breiman, MD (Executive Secretary), National Vaccine Program Office, Centers for Disease Control and Prevention, Atlanta, Ga; Michael Decker, MD, Vanderbilt University School of Medicine, Nashville, Tenn; Mary desVignes-Kendrick, MD, City of Houston Department of Health and Human Services, Houston, Tex; Gordon R. Douglas, Jr, MD, Merck and Co, Whitehouse Station, NJ; Theodore C. Eickhoff, MD,* University of Colorado Health Sciences Center, Denver; Amy Fine, Health Policy/Program Consultant, Washington, DC; James E. Foy, DO, American Association of Health Plans, Columbus, Ohio; Jerome Klein, MD, Boston University School of Medicine, Boston, Mass; Francois LaForce, MD, The Genesee Hospital, Rochester, NY; Myron M. Levine, MD,* University of Maryland School of Medicine, Baltimore; Yvonne A. Maldonado, MD, Stanford University School of Medicine, Stanford, Calif; Thomas P.C. Monath, MD, OraVax, Inc, Cambridge, Mass; June E. Osborn, MD, Josiah Macy, Jr Foundation, New York, NY; Peter Paradiso, PhD, Wyeth-Lederle Vaccines and Pediatric American Home Products, West Henrietta, NY; Stanley Plotkin, MD, Pasteur Merieux Connaught, Doylestown, Pa; Gregory Poland, MD, Mayo Clinic and Foundation, Rochester, Minn; M. Patricia Quinlisk, MD, Iowa Department of Public Health, Des Moines; Daniel W. Shea, MD,* American Academy of Pediatrics, DePere, Wis; David R. Smith, MD,* Texas Tech University Health Science Center, Lubbock; Marian Sokol, PhD, Any Baby Can, Inc, San Antonio, Tex; Daniel B. Soland, PH,* SmithKline Beecham Pharmaceuticals, Philadelphia, Pa; Patricia N. Whitley-Williams, MD, Robert Wood Johnson Medical School, New Brunswick, NJ; and Donald Williamson, MD, Alabama Department of Public Health, Montgomery. (An asterisk indicates retired NVAC members.)

JAMA. 1999;282(4):363-370. doi:10.1001/jama.282.4.363

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.