What will it take to fully protect all American children with vaccines?
A. R. Hinman
Center for Prevention Services, Centers for Disease Control, Atlanta, GA.
Although 95% of children have had a full course of vaccines by the time
they enter school, immunization levels among poor inner-city preschoolers
may be substantially lower. Among the factors responsible for the disparity
are the lack of a uniform data system to identify children who need
vaccine; missed opportunities to offer immunizations; overinterpretation of
contraindications; and administrative barriers to immunization. Remedies
lie in a multifaceted approach: a tracking system that will prompt a
reminder and then sound an alarm when an immunization is overdue; means of
informing parents, probably best accomplished by an outreach worker of the
same racial or ethnic background as the parent; removal of administrative
barriers and increased access to services; incentives, either positive or
negative, to raise the priority of immunizations; and more education for
health care providers to ensure that they understand contraindications and
do not miss opportunities to offer vaccines. Other possibilities are
"express lane" services to immunize all children who come to a health care
provider and the delivery of immunizations in child care settings and in
programs such as Women, Infants, and Children, and Aid to Families With
Dependent Children.
