Vaccines for Children

More than 95 percent of the nation's children receive recommended vaccinations by the time they enter school. Preschool children were overrepresented, however, in the widespread measles outbreaks of 1989-91, a situation attributed to underimmunization. The Vaccines for Children Program, created in 1993, is intended to boost immunization coverage for children by reducing the costs of the vaccines for their parents. Yet GAO concludes that the cost of vaccine for parents has not been a major barrier to childrens' timely vaccination. Moreover, the Centers for Disease Control cannot guarantee that the program will reach pockets of need--areas or populations in which immunizations rates are low and the risk of disease is high. GAO concludes that better use of Medicaid, public health clinics, and other health providers may hold a better promise of immunizing children against disease at a cost lower than that of the program. GAO summarized this report in testimony before Congress; see: Vaccines for Children: Refocusing the Program's Goals and Implementation, by Kwai-Cheung Chan, Director of Program Evaluation in Physical System Areas, before the Subcommittee on Health and Environment, House Committee on Commerce. GAO/T-PEMD-95-23, June 15, 1995 (18 pages).

GAO found that: (1) the cost to parents of vaccines has not been a major barrier to children's timely immunization; (2) immunization rates for preschool children before the VFC Program were at or near the 90-percent national goals; (3) VFC implementation remains incomplete in six of the seven critical areas, including provider enrollment, provider reimbursement policy, order processing and automation arrangements, vaccine distribution systems, accountability provisions, and evaluation planning; (4) the Centers for Disease Control and Prevention (CDC) cannot ensure that VFC will reach high-risk populations; (5) CDC-funded studies have shown promise for improving immunization rates by coordinating immunization services with large public programs such as the Special Supplemental Food Program for Women, Infants, and Children and Aid to Families with Dependent Children Program; and (6) research has linked improved immunization with provider-based strategies, such as assessing clinic immunization practices, obtaining feedback, and implementing recall systems, which can reduce the number of missed opportunities for immunization.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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