Table Of ContentFINANCING
VACCINES
IN THE 21ST CENTURY
Assuring Access and Availability
Committee on the Evaluation of Vaccine Purchase Financing
in the United States
Board on Health Care Services
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
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Committee on the Evaluation of Vaccine Purchase Financing in the United States
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Library of Congress Cataloging-in-Publication Data
Financing vaccines in the 21st century : assuring access and availability /
Committee on the Evaluation of Vaccine Purchase Financing in the United
States, Board on Health Care Services.
p. ; cm.
Includes bibliographical references.
ISBN 0-309-08979-4 (pbk.)—ISBN 0-309-52619-1 (PDF)
1. Vaccination—United States—Planning. 2. Vaccines—Economic aspects—
United States. 3. Vaccination—Economic aspects—United States. 4.
Vaccination—Government policy—United States.
[DNLM: 1. Mass Immunization—economics—United States. 2. Vaccines—
economics—United States. WA 110 F4818 2003] I. Title: Financing vaccines in
the twenty-first century. II. Institute of Medicine (U.S.). Committee on the
Evaluation of Vaccine Purchase Financing in the United States.
RA638.F54 2003
614.4'7—dc22 2003018817
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COMMITTEE ON THE EVALUATION OF VACCINE PURCHASE
FINANCING IN THE UNITED STATES
FRANK A. SLOAN, Ph.D. (Chair), J. Alexander McMahon Professor of
Health Policy and Management, and Professor of Economics, Duke
University, Durham, North Carolina
STEVE BERMAN, M.D., Professor and Head, Section of General
Academic Pediatrics, and Director, Children’s Outcomes Research
Program, University of Colorado School of Medicine and The
Children’s Hospital, Denver, Colorado
DAVID CUTLER, Ph.D., Professor, Department of Economics, Harvard
University, Cambridge, Massachusetts
ERIC FRANCE, M.D., M.S.P.H., Chief of Preventive Medicine, Kaiser
Permanente-Colorado, Denver, Colorado
WILLIAM J. HALL, M.D., Chief, General Medicine/Geriatric Unit,
University of Rochester School of Medicine and Dentistry,
Rochester, New York
DAVID R. JOHNSON, M.D., M.P.H., Deputy Director and Chief
Medical Executive, Michigan Department of Community Health,
Lansing, Michigan
ALISON KEITH, Ph.D., Consultant, Health Economist, Pfizer, Inc.
(retired), Springdale, Utah
JUNE O’NEILL, Ph.D., Professor of Economics and Finance, Zicklin
School of Business, Baruch College, City University of New York,
New York, New York
MARK PAULY, Ph.D., Bendheim Professor and Chair, Health Care
Systems Department, The Wharton School, University of
Pennsylvania, Philadelphia, Pennsylvania
SARA ROSENBAUM, J.D., Hirsh Professor and Chair, Department of
Health Policy, George Washington University Medical Center,
School of Public Health and Health Services, Washington, D.C.
IRIS R. SHANNON, Ph.D., R.N., Health Consultant and Associate
Professor, Health Systems Management, Rush University, Chicago,
Illinois
Committee Staff
Rosemary Chalk, Study Director
Robert Giffin, Ph.D., Senior Program Officer
Nakia Johnson, Senior Project Assistant
Ryan Palugod, Senior Project Assistant
v
Independent Report Reviewers
This report has been reviewed in draft form by individuals chosen for
their diverse perspectives and technical expertise, in accordance with pro-
cedures approved by the National Research Council’s Report Review
Committee. The purpose of this independent review is to provide candid
and critical comments that will assist the institution in making its pub-
lished report as sound as possible and to ensure that the report meets
institutional standards for objectivity, evidence, and responsiveness to the
study charge. The review comments and draft manuscript remain confi-
dential to protect the integrity of the deliberative process. We wish to
thank the following individuals for their review of this report:
WILLIAM V. CORR, Executive Vice President, National Center for
Tobacco-Free Kids, Washington, DC
HELEN DARLING, M.A., President, Washington Business Group on
Health, Washington, DC
SHERRY GLIED, Ph.D., Assistant Professor of Public Health, Colum-
bia University, New York, NY
HENRY G. GRABOWSKI, Ph.D., Professor of Economics and Direc-
tor of the Program in Pharmaceuticals and Health Economics, Duke Uni-
versity, Durham, NC
RUTH J. KATZ, J.D., M.P.H., Associate Dean of Administration, Yale
University, New Haven, CT
TRACY LIEU, M.D., M.P.H., Associate Professor, Department of
Ambulatory Care and Prevention, Harvard University, Boston, MA
vii
viii INDEPENDENT REPORT REVIEWERS
BARBARA D. MATULA, M.P.A., Consultant, Health Care Access
Program, North Carolina Medical Society Foundation, Raleigh, NC
GEORGES PETER, M.D., Professor and Vice-Chair for Faculty Af-
fairs, Department of Pediatrics, Brown Medical School, Providence, RI
JEFFREY L. PLATT, M.D., Professor of Immunology, Mayo Clinic,
Rochester, MN
WILLIAM SCHAFFNER, M.D., Professor and Chairman, Depart-
ment of Preventive Medicine, Vanderbilt University, Nashville, TN
DAVID TAYLOE, JR., M.D., Goldsboro Pediatrics, Goldsboro, NC
THOMAS VERNON, M.D., Executive Director, Medical, Scientific,
and Public Affairs, Merck Vaccine Division, West Point, PA
Although the reviewers listed above have provided many construc-
tive comments and suggestions, they were not asked to endorse the
report’s conclusions or recommendations, nor did they see the final draft
of the report before its release. The review of this report was overseen by
William L. Roper, M.D., M.P.H., Dean of the School of Public Health,
The University of North Carolina at Chapel Hill, and Willard Manning,
Ph.D., Professor, Department of Health Studies, The University of Chicago.
Appointed by the National Research Council and the Institute of Medi-
cine, they were responsible for making certain that an independent
examination of this report was carried out in accordance with institu-
tional procedures and that all review comments were carefully consid-
ered. Responsibility for the final content of this report rests entirely with
the authoring committee and the institution.
Contents
EXECUTIVE SUMMARY 1
1 INTRODUCTION 21
Background, 22
Conceptual Framework for the Study, 26
Study Process, 35
Summing Up, 36
Organization of the Report, 37
2 ORIGINS AND RATIONALE OF IMMUNIZATION POLICY 39
Legislative History of Vaccine Policy, 45
Shared Federal and State Responsibility for Financing, 47
Shared Public and Private Responsibility for Coverage, 49
Public and Private Delivery Systems, 51
Private Vaccine Production, 52
The Setting of National Vaccine Policy, 56
Findings, 61
3 PUBLIC AND PRIVATE INSURANCE COVERAGE 63
Public Insurance Coverage, 66
Private Insurance Coverage, 69
Barriers to a Well-Functioning Immunization Finance System, 73
Findings, 89
ix
