Background Paper Prepared for the Committee on the Evaluation of

For the past 15 years, there has been a tacit expectation among many health policymakers that the financing of childhood immunizations would be a shared responsibility of the private and public sectors. Employers and private health insurance would cover the costs of immunizing children of workers, and the federal and state governments would be responsible for financing the immunizations of low-income uninsured and underinsured children, as well as children covered by Medicaid. Until 15 years ago, the costs of immunizing a child were relatively low. In 1987, the combined catalog price of all childhood vaccines was $116; ten years later, the total price was between $332 and $370 (IOM, Calling the Shots, p. 57). Since 1985, the number of recommended childhood vaccines has doubled, helping to drive the total price of the recommended vaccines up. The rising costs and number of current childhood vaccines have raised concern that the shared private-public responsibility for childhood immunizations may be shifting from a 50-50 split to one where the private sector is reducing its commitment to financing immunizations. This concern has been partly fueled by anecdotal stories related to the recent shortages of vaccine supplies to private and public providers. The anecdotes describe physicians in privat