BACKGROUND:
In an earlier study, the authors identified an evolving body of public health research that recognizes several strategies that states can implement to increase childhood immunity from vaccine-preventable diseases: (1) state-wide, population-based immunization registries; (2) immunization registries that are “opt-out”; (3) adequate reimbursement rates for vaccine administration; (4) public-private coalitions to promote immunization; (5) incentives for immunization providers to employ effective reminder and recall systems and to assess their records; (6) strong enforcement of state laws and regulations requiring immunization for children entering daycare.

OBJECTIVE:
This research describes how state immunization program managers perceive the impact and importance of these strategies toward attaining the goal of full childhood immunization.

METHOD:
The authors collected data from a 50-state telephone survey of state immunization program managers administered in April and May, 2003. All 50 states participated in the interview process.

RESULT:
Our findings suggest officials in state immunization programs hold diverse opinions about the importance, impact, and feasibility of implementing these strategies. For example, there is significant consensus about the importance and effectiveness of state registries, but much less consensus about the impact and importance of universal purchase systems and mandated AFIX/CASA participation.

CONCLUSION:
The implementation of opt-out registries, increased participation in AFIX and CASA, universal purchase systems, and higher Medicaid reimbursement rates are associated with higher childhood immunization rates. Nonetheless, political ideology, constrained state budgets, and a lack of consensus about the effectiveness of some programs will continue to make programmatic intervention a difficult challenge.

LEARNING OBJECTIVES:
Conference participants will learn more about how state immunization program managers think about some of the most important immunization policy initiatives. These insights are particularly important for both high level policy makers and those working to implement these key strategies at the local level.