KEYWORD1:
state immunization programs, vaccine purchase financing

BACKGROUND:
State immunization programs (SIPs) are major purchasers of vaccines, particularly for the Vaccines for Children (VFC) program. Due largely to the increasing cost of vaccines, states are facing increasingly difficult financial and policy decisions regarding vaccine purchase. Consideration of the appropriate balance of roles and responsibilities for financing vaccine purchase must take into account the states’ perspectives.

OBJECTIVE:
To gain insight into state policies and experiences regarding the financing of vaccine purchase and the factors affecting state vaccine purchase decisions.

METHOD:
Structured interviews were conducted with state immunization program managers and designated staff from 47 states and the District of Columbia.

RESULT:
About 60% of the states interviewed had run out of federal vaccine purchase funds at least once in the past five years. Variability in the distribution of federal funds to states has created difficulties for vaccine purchase planning. Due to the cost of newly recommended childhood vaccines, several states that typically purchased vaccines for more subgroups of children than those eligible for VFC have had to restrict availability of these vaccines to VFC-eligible children only. States’ top concerns related to vaccine purchase fell into the following four categories: (1) vaccine supply, (2) vaccine purchase funding (federal and state), (3) vaccine prices, and (4) funding for adult immunizations.

CONCLUSION:
The wide variability across states, such as in the population subgroups for whom they purchase vaccines and the availability of state vaccine purchase funding, should discourage development of a "one-size-fits-all" approach for funding state vaccine purchase. Improvements in the existing federal funding process can be made.
LEARNINGOBJECTIVES:
Describe issues and challenges with respect to vaccine purchase from viewpoint of state immunization programs. Allow state immunization programs to learn how their situation and perspective compares to those of other states.