The Role of Measles Elimination in Development of a National Immunization Program

Abstract

The U.S. Immunization Program has been one of the most successful efforts in preventive medicine. Since its beginning with passage of the Vaccination Assistance Act in 1962, polio, measles and rubella have been eliminated and many other vaccine-preventable diseases are at record or near record lows. In 1966, 3 years after licensure of the first measles vaccines, the Centers for Disease Control and Prevention began an effort to eliminate measles within the United States, an on-and-off effort that was to last more than 30 years. With measles elimination as the primary driver, fundamental components of today's immunization program were built that affected not only measles, but all of the vaccines and vaccine-preventable diseases of childhood. Some of the major contributions were the enactment and enforcement of immunization requirements for school attendance in all 50 states, enactment of an entitlement program for vaccine purchase, the Vaccines for Children Program, support for health services research to determine reasons for nonimmunization and interventions to improve coverage, development of standards for immunization practices and the measurement system for immunization coverage in all 50 states and 28 major urban areas. Key lessons have been: (1) the program must rest on a sound base of vaccine science and health services science; (2) having a limited number of measurable goals allows program focus, but consider strategies that have crosscutting impact; (3) accountability is critical to program performance at all levels-state, local and individual practice; and (4) establishing and maintaining political support is essential.

Beyond vertical and horizontal programs: a diagonal approach to building national immunization programs through measles elimination

“…For example, in the United States, measles elimination goals played a key role in the development of the National Immunization Program [10,11]. First licensed in the United States in 1963, measles vaccines were first provided through a new Federal Immunization Program in 1965, called the 317 program, the first new vaccine introduced since the program began.…”

The Ethical Imperative to Eradicate Measles

“…Measles is one of the most contagious vaccine-preventable diseases, and is a sensitive indicator of problems in immunization programmers because of its high communicability and recognizable rash [25]. The surveillance resolution required for rapid detection, confirmation, and response to measles would permit measles outbreaks to accurately identify specific communities missing out on measles vaccine but also other primary health care services.…”

Preventing cervical cancer

“…33 Analyses suggest that these observed findings are attributable to disparities in coverage by poverty level as well as to differences in income distributions among black and white populations. 33 Although the VFC program and the 317 program are recognized as having contributed to the achievement of high national vaccine coverage levels among children, 24,33,34 barriers to vaccination remain. The 2008 National Immunization Survey will include a module of questions that will be used to gain understanding of barriers to vaccination affecting socioeconomically disadvantaged groups as well as racial/ethnic populations.…”

“…23 Private and public providers who participate in the VFC program in over 47,000 sites 18 vaccinate eligible children with federally purchased VFC vaccines as approved through resolutions by CDC's Advisory Committee on Immunization Practices (ACIP). 23,24 Children aged 18 years and younger who are Medicaid eligible, uninsured, and/or American Indian or Alaska Native (as defined by the Indian Health Care Improvement Act) are eligible to receive vaccine from providers through the VFC program. 25 Children in this age group who are categorized as ''underinsured'' (because their health plans do not include coverage for recommended vaccinations) may receive VFC vaccines if they are served by a rural health clinic (RHC) or Federally Qualified Health Center (FQHC).…”

“…[26][27][28][29] Although the VFC and 317 programs differ in several important aspects, they are similar in that they provide vaccines at no cost to targeted populations. The 317 program was created in 1962 by the Vaccination Assistance Act 24 and initially allowed use of discretionary funds for vaccine purchase and programmatic activities (eg, outbreak control, disease surveillance, program administration, planning, and evaluation). Additional 317 program funding was allocated 30 years later in the aftermath of a measles epidemic, and, for the first time, resources were directed to support infrastructure and direct service delivery.…”