A Blueprint

for

Sustained Success

N A T I O N A L I M M U N I Z A T I O N P R O G R A M

Strategic Plan

2000-2005

achievements of the 20th century. Smallpox no longer exists. The

threat of polio is close to being eradicated. The number of

measles cases in the United States is at an all-time low. In the

history of vaccine development and use, major challenges have

been successfully overcome, and many lessons have been

learned. The National Immunization Program (NIP) can help

focus national efforts and assist in global efforts to prevent

disease by providing public health leadership on vaccination

issues.

Our challenge is to effectively balance our efforts in the domestic

and global arenas as well as accommodate the specific needs of

all populations at risk of vaccine preventable diseases from

children to older adults.

On the domestic front, our Nation has made outstanding

progress in increasing the U.S. immunization rate in children by

the time they are 2 years of age. In 1997, the 90 percent vaccination

coverage goals of the Childhood Immunization Initiative

(CII) were met. The increase in overall immunization coverage

has included increases in coverage for children living both

above and below the poverty level as well as for children of all

major racial and ethnic groups.

Despite these gains, every day in the United States, 11,000

babies are born who must be vaccinated. To be protected against

10 vaccine-preventable diseases, they should receive 12-16 doses

of vaccines by 18 months of age and 16-20 doses through childhood.

We are still challenged to improve childhood immunization

rates for newer vaccines, such as Varicella (chicken pox)

and Hepatitis B, that have not yet reached 90 percent coverage.

In order to address the challenges we face with the childhood

population, we must commit to remaining diligent—for ironically,

it is our past success that can threaten our ability to sustain our

achievements. Some diseases have been so well controlled by

the use of vaccines that the public and many healthcare

providers have no memory of them ever existing. Ignored, this

loss of awareness can lead to public apathy about the need for

vaccination and, more dangerously, a loss of political will to

sustain vital immunization interventions.

Furthermore, changes in healthcare financing are causing the

responsibility for childhood immunization to shift to the private

sector. Since October of 1994, the Vaccines for Children (VFC)

program has been providing publicly purchased vaccine to

eligible children at no charge to both public and private

providers. By eliminating vaccine cost as a barrier to immunizing

children, the practice of referring children from the private to

the public sector for vaccination has been reduced. The 1999

National Immunization Survey (NIS) showed that private

providers administered more than 61 percent of immunizations.

This proportion will likely rise each year as more children are

insured through Medicaid Managed Care and the Child Health

Insurance Program (CHIP). Therefore, the public health sector

must make certain that it provides support to the private sector

in order to maintain the record high immunization coverage

rates achieved over the past several years. In particular, NIP

must revisit its traditional approach to providing vaccines

primarily through public health providers and further develop

its role in immunization assessment and assurance in order to

document continued program effectiveness.

While the NIP continues to build an immunization system to

protect children, we are also working to improve immunization

rates in other populations, such as adolescents, adults, diverse

racial and ethnic populations, and pockets of need, where we

still fall short of our goals. For example, for each one-year age

group of unvaccinated adolescents, as many as 160,000 may

become infected with hepatitis B virus, which will result in

10,000 chronically infected individuals and 1,400 deaths,

primarily from cirrhosis and liver cancer. We must do more to

provide services to adolescents before they leave high school

and become difficult to reach as young adults.

We must be equally committed to our adult population, where

loss of life and costs from vaccine-preventable diseases are

staggering. Each year, about 30,000 adults die from complications

of influenza, pneumococcal disease, and hepatitis B, all preventable,

at an annual cost to the nation’s taxpayers of over 10 billion

dollars. Immunizations rates for adults 65 years of age and

older, while increasing, are still well below 90% coverage goals.

In 1998, the National Health Interview Survey (NHIS) indicated

that pneumococcal vaccination coverage among persons aged

65 and over was only 46%. The NHIS also identified significant

racial and ethnic disparities in the adult population, with African

Americans reporting a 26% coverage rate and Hispanics a 23%

coverage rate compared to a 49% rate in the white population.

In addition to our domestic efforts, NIP is also making a strong

commitment to global immunization efforts. Wild polio circulation

has been absent in the United States since 1980. NIP is

currently working with international partners to help achieve

global certification of polio eradication by 2005. The World

Health Organization (WHO) estimates that in 1988, polio existed

in over 125 countries on five continents, and caused more than

350,000 children to be paralyzed that year. By the end of 1999,

the number of polio-infected countries decreased to 30 and

reported polio cases fell to 7,012. While polio eradication is in

sight, the final steps—which will require intensified efforts in

the most populous countries and unique strategies for war-torn

countries—remain the most difficult. Even as we near that

monumental goal, we are working to marshal the same resources

toward worldwide eradication of the most common cause of

vaccine-preventable death in the world, measles. Currently,

measles accounts for almost 1 million preventable deaths worldwide.

NIP, together with the National Center for Infectious

Disease's Measles Lab, participates as a key partner organization

in an initiative led by the Pan American Health Organization

(PAHO) to eliminate indigenous transmission of measles in the

Americas by the end of 2000. Measles is currently at record low

levels in the Western Hemisphere with less than 700 cases

reported during the first seven months of 2000.

Our global goals will be accomplished through effective partnerships

with Rotary International, our counterparts at WHO, the

Task Force for Child Survival and Development, UNICEF, other

international groups including the American Red Cross and

International Federation of Red Cross/Red Crescent Societies,

and individual countries. Currently, dozens of NIP staff are

stationed in foreign countries working to help make both global

polio eradication and measles elimination a reality. In 1999, NIP

staff began providing assistance to the new Global Alliance on

Vaccines and Immunization (GAVI) to address the issues of

strengthening immunization programs, introducing new

vaccines in countries that have previously been unable to afford

them, and advancing development of vaccines targeted at

diseases predominating in less-developed countries.

We have experienced many successes, and lessons from the past

ready us for the next set of challenges. To identify these challenges

and explore ways to address them, NIP sought input

from a diverse group of NIP constituents, including private and

public health providers, community organizations, government

agencies, and national and international associations. Our issues

are complicated. What new goals do we need to develop? Which

strategies will give us the best results? How do we ensure that

we sustain our past achievements? What systemic changes do

we need to make to our organization or the infrastructure to

meet new goals and challenges? Who are the new partners we

should engage? What additional resources are available?

In "A Blueprint for Sustained Success," you will find our

collective response to these and other important questions. The

document is a comprehensive map, developed by persons who

are committed to creating a vaccine-preventable disease-free

world. We invite you to join with us in our work, for we cannot

do it alone. Whatever your capacity—healthcare provider, community

advocate, policy maker, business person, NIP employee,

mother or father—you can play a role in shaping the policies

and implementing the strategies that will help us to achieve our

unique public health mission.

and defining strategies and systems for monitoring our

progress. This planning process—and the work that will come to

translate the plan into action—are informed and guided by the

public health priorities of the Centers for Disease Control and

Prevention (CDC). The commitments that we share will assure

that our work is carried out in a spirit of cooperation to promote

excellence.

NIP has played a significant role in identifying and articulating

the opportunities and challenges of developing an effective

immunization "system" for the country. We intend to maintain

and strengthen this role through the implementation of our

strategic plan. We will influence effective immunization policy

by conducting quality research, engaging public support, and

partnering with a wide range of professional and other

organizations.

One of the NIP’s most important responsibilities is to conduct

reliable scientific research on vaccine-preventable diseases,

vaccines, and their delivery. However, we are challenged to

apply research and ensure that our findings make real,

measurable differences in people’s lives. We must work to create

a public health infrastructure that promotes strong science,

including epidemiological, social, behavioral, and health

systems research.

As the primary link between immunization policy and patients,

physicians, nurses and other public and private sector health

care providers must have the skills and knowledge necessary to

implement proper immunization and clinical practices and

educate adolescents, adults and parents regarding proper

immunization.

NIP has experienced first-hand the beneficial impact of

collaboration and partnerships. We have effective partnerships

with organizations such as Rotary International, the World

Health Organization, the American Academy of Pediatrics

(AAP), the American Academy of Family Physicians (AAFP),

the Association of State and Territorial Health Officials

(ASTHO), and UNICEF. We also partner with managed care

organizations, Medicaid, and Medicare, as well as State and

local organizations.

The results of these partnerships have already begun to show. A

partnership among NIP, AAP, AAFP and the Advisory

Committee on Immunization Practices (ACIP) has recommended

a harmonized Childhood Immunization Schedule to guide

public and private sector providers on the delivery of immunization

services to children, eliminating the confusion that

resulted from different recommendations from various groups.

Through these partnerships, we have not only implemented

innovative and effective intervention programs, but also

succeeded in gaining the attention of other key audiences—

corporate and community leaders and the media—to help

achieve our mission.

To ensure that childhood immunizations remain at high levels

and that more adolescents and adults are immunized,

immunization must be emphasized every time anyone, at any

age, receives preventive and acute healthcare services.

NIP will help bring this about by being a resource for reliable

research and information to keep the public knowledgeable

about immunization issues. We will support a daytime hot-line

that parents and others may call for information. Working with

our partners, we will continue to support information-exchange

and scientific assistance opportunities similar to those on the

world-wide web, and participate in activities such as National

Infant Immunization Week and Adult Immunization Awareness

Week.

Finally, NIP will work to ensure that citizens receive balanced

information about vaccines. While there are some rare health

risks associated with vaccinations, research and experience

demonstrate that the benefits of vaccines far outweigh the risks

for almost all persons for whom they are indicated. Recognizing

that informed consumers will make appropriate choices, we

commit to work diligently to ensure that accurate and complete

immunization information is made available.

There are glaring health disparities among developed and

developing nations. Therefore, NIP will work very closely with

both established and new global partners to provide immunization

expertise to strengthen and expand global childhood

immunization programs. Global activities will include improving

routine immunization, introducing new vaccines and micronutrients,

and conducting disease surveillance and program

assessment. NIP is committed to making polio eradication a

reality, pursuing efforts to eliminate or better control measles

and rubella, and introducing new vaccines.

the future. However, expectations alone will not drive progress.

We recognized a need to develop a blueprint to guide our

improvement and progress and ensure that we maintain healthy

relationships with our staff and constituents.

mission, we established goals in seven key areas:

1. Disease Prevention 5. Systems

2. Immunization Coverage 6. Vaccine Safety

3. Partnerships 7. NIP Work Environment

4. Science

In order to maximize resources, improve inter- and intra-agency

communications, improve the collection, analysis and

dissemination of information, increase the effectiveness of our

studies, and protect the integrity, security and the privacy of

public health data, NIP is committed to utilize the National and

Global Information Infrastructures to achieve its goals and

related strategies. Furthermore, NIP will work with the other

Centers, Institutes, and Offices within CDC and its HHS and

outside partners to enhance the Nation's Healthcare and Public

Health Information Infrastructure.

These goals will guide our work for the future. For each of these

goals, we have identified priority strategies—those activities

that will have the greatest and most immediate impact on

success. Additionally, we developed specific, quantifiable

objectives so that we can monitor our progress toward achieving

these goals.

response systems in collaboration with state and local

partners

The intent of Goal 1 is to decrease the occurrence and existence

of diseases. Once a disease occurs, effective, continuous

intervention will decrease the occurrence of the disease to an

acceptable level. A disease is not considered eradicated until it

has been halted throughout the world. To achieve this goal, the

NIP will continue to create and enhance surveillance systems for

children, adolescents, and adults that will enable us to monitor

disease elimination and reduction efforts.

As a core public health function, surveillance systems must have

adequate funding and be maintained in partnership with state

and local organizations. In addition, the introduction of newer

vaccines to the childhood schedule increases the need for

effective surveillance to measure the impact vaccination has on

disease occurrence.

We cannot cease our work to control any given disease until it

has been globally eradicated. The global eradication of polio is,

therefore, another major focus. In collaboration with global

partners, NIP will assist in the implementation of the fourpronged

strategy in polio endemic or recently endemic areas to

eradicate polio worldwide:

1. high routine immunization with the Oral Polio Vaccine

(OPV);

2. supplementary immunization in the form of national

immunization days and mass campaigns;

3. effective epidemiologic and laboratory surveillance of

suspected and confirmed polio cases; and

4. in the final stages, "mopping up" campaigns which

involve immunizing communities by going door to door in

areas where the virus persists.

immunization registries

effective to enhance childhood and adult immunization

and adult immunization coverage levels at national, state

and local levels

coverage levels globally

successful negotiation of contracts, efficient vaccine

ordering, and safe and timely delivery

Goal 2 seeks to increase immunization coverage rates by

constantly assessing the use of vaccines. Because we feel it is

necessary to institutionalize our strategies proven to increase

coverage rates, many of the strategies used to accomplish this

goal will also be measured through our Systems Goal (Goal 5).

NIP strongly promotes the use of state and community-based

immunization registries by public and private health providers.

Effective immunization registries provide the most comprehensive

record of immunization rates because they consolidate

immunization information from a variety of sources. Registries

can be used to help remind parents and patients of the need for

immunizations and immunization appointments, as well as

advising health care providers and practitioners when their

patients’ immunizations are due or overdue.

NIP also will expand upon strategies proven to assure and

improve the quality of immunization services for children and

adults. The AFIX system—Assessment, Feedback, Incentives,

information eXchange—is our version of Continuous Quality

performance of individual public and private providers;

among providers. Thus, providers improve their performance by

comparing their immunization coverage levels in the populations

they serve with the coverage levels of their peers.

Another proven strategy to enhance coverage is NIP’s partnership

with the Women, Infants and Children Program (WIC). WIC

is the largest single point of access to health-related services for

low-income preschool children, with approximately 1.8 million

infants participating. Demonstration projects that linked WIC

services with immunization delivery significantly increased

immunization levels by as much as 34 percentage points.

Immunizing adolescents and adults is a more complicated

undertaking than immunizing children. Vaccination recommendations

for adults depend on a person’s age, occupation, health

status, and behavior. Also, the diseases to be prevented are often

clinically indistinguishable from similar syndromes, making

assessment of the impact of immunization difficult. NIP will

expand the use of AFIX to assess adult and adolescent

immunization rates. As with the childhood population, the key

to increased adolescent and adult coverage appears to be the

performance of the physicians and nurses with whom patients

interact. NIP will continue to support quality immunization

training and education programs for these professionals.

New vaccines for many diseases, including Lyme disease and

pneumococcal and meningococcal disease, have been recently

developed. More are on the way including new vaccines against

influenza, parainfluenza, and respiratory Syncytial Virus (RSV).

Vaccines are also in development to prevent chronic diseases

like gastric ulcers and cancer caused by Helicobacter pylori,

cervical cancer caused by human papilloma virus, and rheumatic

heart disease that can occur as a result of group A streptococcal

infection. While new vaccines offer the opportunity for

increased disease prevention, these additions impact ordering

and inventory systems and place a greater burden on current

disease surveillance and delivery systems.

As we have stated throughout this document, the NIP will

consistently seek opportunities to communicate its progress. We

will continue to facilitate awareness activities, immunization

campaigns, and information opportunities. We also seek to form

relationships with the media to encourage them to help us

effectively communicate our mission and services.

includes an evaluation component for NIP's domestic

agenda that more clearly defines the purpose and

outcomes for each partnership

NIP's vision, mission and goals

NIP has been able to inform and influence immunization work

and practice by establishing effective partnerships at the global,

national, state, and local levels. Our strategic plan will guide us

in forming new alliances which leverage and expand upon our

current resources.

We will continue to seek partners who can help us reach our

"pockets of need"—defined as an area or population with low

immunization coverage, a large number of undervaccinated children

and high potential for disease outbreaks. These "pockets"

are closely associated with low socioeconomic status and

cofactors such as crowded living conditions, low parental educational

level, large family size, and young parental age. These

populations have a critical need for resources and assistance.

NIP must ensure that our relationships are not based solely

upon financial incentives. Together with our partners we must

each identify our unique contributions to this effort. Each

partner brings a unique experience and resource to help protect

the children and adults of our country and the world from

vaccine-preventable diseases.

We are committed to expanding upon our existing partnerships

by reaching out to "newer" players and other critical constituencies.

Some of these include public health officials, health carefinancing

organizations, and other national and international

agencies. The healthy growth of our relationships with partners

is critical to sustained success.

reviewed and updated NIP research agenda linked to

goals and objectives

translation of science to policy and program

Guided by the strategic plan, NIP will coordinate the routine

development of a research agenda to ensure that our work

supports achieving our mission. To help develop this agenda,

we will meet with experts and support scientific discussion

devoted to reviewing current research needs and strategically

identifying and prioritizing our research agenda.

However, we know much of what our research agenda must

include: an improved understanding of the epidemiology and

impact of vaccination on vaccine preventable diseases; vaccine

safety and risk communication; improved methods for

immunization research, surveillance, and practice; and

international issues surrounding eradication of disease. Our

research will focus on vaccine preventable disease in adults and

adolescents, where coverage has lagged and mortality remains

high. We will also continue to promote research in the childhood

arena, including research leading to the appropriate implementation

and evaluation of new vaccines and associated

technologies. Optimizing the immunization schedule requires a

range of studies of vaccine delivery and cost; studies of immune

response; and modeling of disease impacts. Our research must

also address the most appropriate analytic methods to accurately

evaluate associations between vaccines and adverse events,

monitor coverage, and assess delivery practices. As new, more

expensive vaccines and vaccine combinations are introduced,

we will use our expertise in science and epidemiology,

economic analysis, and data management to improve methods

for collection and analysis of data on vaccine economics and

cost-effectiveness.

Widespread use of vaccines has led to significant decreases in

child mortality in developing countries, but further progress is

needed. In addition, controlling vaccine-preventable diseases

internationally will decrease importation of causative agents

and the potential for epidemics in the United States. In this area,

we will study the scientific basis for stopping polio vaccination

following global eradication, the effectiveness of different

strategies for achieving accelerated control and/or elimination

of measles, and improved technologies for high-speed, safe

delivery of vaccines such as needleless injectors for mass

measles campaigns. We will also promote the development and

implementation of new vaccines globally.

of the core functions of immunization programs is

adequately reflected in each State's grant

tools to grantees in the United States and assistance to

countries globally to build technical and administrative

capacity

purchasing specifications for Medicaid managed care

and other mechanisms for assuring immunization and

vaccine-preventable disease services

Immunization Days (NIDs), acute flaccid paralysis (AFP)

surveillance, mop-up immunization campaigns, global

laboratory network for polio, measles, and rubella,

strengthening routine immunization, and initiatives of GAVI.

The NIP provides grants to 64 immunization grantees to support

effective immunization systems and high rates of coverage. To

ensure high quality performance and promote accountability,

NIP will identify expectations for grant recipients that include

critical core functions required of all immunization programs.

Working with our grantees, NIP will provide data which will

help to more effectively build and sustain systems for information,

surveillance and vaccine purchases. Additionally, NIP will

provide grantees with scientific assistance for evaluation,

delivery, communications, and partnership development.

We must ensure that an adequate immunization infrastructure is

maintained to guarantee the effective delivery of vaccines.

Financial barriers must not prevent even the poorest citizen

from receiving vaccines. As children and adults move into

managed health care, the Child Health Insurance Program, and

other programs evolve, the NIP must help to assure that immunization

coverage is a component of all health insurance plans.

On the global front, overcoming obstacles and ensuring the

highest quality of immunization activities in the 30 remaining

polio-endemic countries will be given the highest priority. In

particular, efforts will focus on countries where polio transmission

is particularly intense due to large, dense populations, low

routine coverage, and poor sanitation and where implementation

of vaccination and surveillance activities is particularly challenging

due to weak or destroyed infrastructure. Central to the

success of polio eradication is ensuring that extra rounds of

high-quality NIDs are conducted in these priority countries.

During the mop-up phase of polio eradication, high-quality

AFP surveillance is essential to identify the remaining pockets

of polio and to target immunization activities to break the final

chains of transmission.

Building on the models of successful partnerships to achieve

smallpox and polio eradication, GAVI intends to improve global

childhood immunization by expanding these programs to

include new vaccines and strengthen immunization systems.

NIP will work with international partners to provide immunization

expertise and strengthen the technical capacity of countries

to sustain childhood immunization programs by improving

routine immunization, introducing new vaccines and micronutrients,

conducting disease surveillance and program

assessment, and evaluating new disease control strategies.

issues

communications

As we continue to successfully reduce the incidence of vaccinepreventable

diseases, we must be sensitive to concerns about

vaccine safety. We cannot minimize the pain and suffering of

one adverse event. We must continue to monitor serious adverse

events to determine whether vaccines cause them, and if so,

what is the risk, and ways this risk could be minimized or

eliminated.

To assure the timely detection and investigation of adverse

events, NIP currently uses two tools. The Vaccine Adverse Event

Reporting System (VAERS) and the Vaccine Safety Datalink

(VSD). VAERS receives about 10,000 reports of suspected

adverse reactions to vaccines annually. We are seeking ways to

improve early detection of potential VAERS clusters using

artificial intelligence. We are also improving the quality and

usefulness of VAERS data by expanding our reporting and

follow-up efforts in new regional Clinical Immunization Safety

Assessment (CISA) Centers. The VSD is a database that contains

comprehensive medical and immunization histories of 6 million

people from four health maintenance organizations. With this

database, it is possible to do research studies that compare the

incidence of health problems between vaccinated persons and

an appropriate comparison group. NIP plans to eventually

expand the VSD to five percent of the U.S. population. This

expansion would increase the statistical ability to identify and

rigorously evaluate rare associations between vaccinations and

potential adverse outcomes. Increasing the size of the database

will also increase the number of scientists involved in vaccine

safety research.

In order to assure the availability of safer vaccines, NIP plans to

increase opportunities for independent research studies on

vaccine safety. These studies could occur shortly after, or in

response to, a new hypothesis involving immunization and

vaccine adverse reactions. Such research could also be used to

evaluate or extend previously published scientific research.

Vaccine safety has become a controversial issue in today's

medical news. The facts regarding vaccine safety can be

obscured by misleading news reports, questionable studies, and

even by well-intentioned persons who have suffered from what

they perceive to be vaccine-related injuries. The complexity of

this issue requires that NIP expand research in the area of

vaccine benefit-risk communications, including parent and

professional education. The research will be designed to identify

communication and education gaps, the best or most effective

ways to communicate vaccine benefits and risks, and the best

channels to place such information. In addition, it will help

guide NIP's efforts to disseminate information electronically.

Safety is not only a domestic issue; it is also an important global

issue. As other national immunization programs attain high

vaccine coverage rates and successfully reduce the incidence of

vaccine-preventable diseases, they are also encountering the

increasing prominence of immunization safety. In less developed

countries, the safety concerns focus less on the rare serious

reactions from the vaccines but rather on unsafe injection

practices. A consortium of partners including NIP, the CDC's

National Center for Infectious Diseases, USAID, and WHO

started the Safe Injection Global Network (SIGN) in 1999. SIGN

supports policy change, new standards for safe injections,

increased availability of safer injection technologies, appropriate

waste disposal, and education and communication initiatives.

supervisory staff

involved in achieving our mission

To be successful, all NIP employees must be informed about the

organization’s activities and recognize their individual roles in

helping to achieve successes. In addition, our staff is our link to

the public and our partners, and they must be equipped and

encouraged to serve as ambassadors to share news of our work

in the communities that they serve.

NIP will continue to develop the processes, policies and systems

that will result in a motivating, creative work environment in

which all staff recognize their responsibilities and role in

implementing our strategic plan. This will not be possible

without skilled leadership. NIP managers must be able to apply

proven supervisory techniques to ensure the most effective and

efficient workforce possible.

achieve the record low disease rates and the highest levels of

vaccination coverage in history. We believe that the implementation

of "A Blueprint for Sustained Success" will help to maintain

the high momentum for immunization coverage. To be successful,

however, the public must understand what the NIP is seeking to

accomplish and see evidence of progress.

The most effective way to monitor success is to measure

progress against a set of measurable objectives, which are

readjusted as appropriate. Therefore, NIP will use the following

measurable objectives to monitor our progress and when the

results of our monitoring show that we should be doing things

differently, we will reexamine our approach and incorporate

changes where appropriate and necessary.

In addition, NIP divisions have developed detailed action plans

that further define the processes and policies needed to reach

our goals; the time frame for activity; and the benchmarks by

which we will judge our progress.

Americas by the end of 2000, Europe by 2007, and the

Eastern Mediterranean Region of WHO by 2010

diseases in the United States.

(in persons under 35 years of age), haemophilus influenzae

type b (in children under 5 years of age), measles, mumps,

wild-type polio, rubella, and tetanus (in persons under 35

years of age).

of age) to 9, pertussis (in children under 7 years of age) to

2,000, varicella to 400,000

vaccine in all countries.

in all countries.

levels for each universally recommended vaccine in the

U.S. among two-year-old children.

U.S. for school enterers and children enrolled in licensed

day-care for each vaccine

vaccine in at least 45 States (including D.C.)

and older in the U.S. who are vaccinated annually against

influenza and ever vaccinated against pneumococcal

disease

to 64 years of age in the U.S. who are vaccinated annually

against influenza and ever vaccinated against pneumococcal

disease

adolescents (13 to 15 years of age) in the U.S. for each

vaccine

within 5 years of introduction for appropriate populations

in the U.S. as designated by ACIP

and socioeconomic group in the U.S. for all vaccines

with key partner organizations on all global immunization

objectives.

strategic planning goals that would benefit most from

partnership development.

would allow us to concentrate efforts on these key issues.

helping us to achieve our mission.

as measured by MMWR's, technical manuals, scientific

papers (submitted, published, and in what journals), and

book chapters.

policy as measured by Recommendations and Reports

including ACIP recommendations, and presentations at

local, national and international conferences.

research.

countries by 2005

measles control by the end of 2000

the end of 2001

will introduce hepatitis B vaccine and all countries by 2007

disease and adequate delivery systems will have

introduced Hib vaccine.

the U.S. who have measured the vaccination coverage

levels among children in their practice populations.

U.S. for all ACIP routinely recommended vaccines.

enrolled in fully operational population based registries.

have a mechanism to pay for vaccinations (private

insurance, Medicaid, Medicare, SCHIP).

U.S. who receive vaccinations as part of comprehensive

primary care.

diseases at the national and state levels as

measured by surveillance indicators.

syringes) for all CDC-funded injectable vaccines

provided for global disease control initiatives

pertussis vaccination by 50%

enhancements to VAERS, VSD, and the CISAs

ACIP recommendations

a) parental, and

b) provider knowledge of the value, risks, and benefits of

measured by an annual survey

training within 6 months of assuming their new position

news updates to all NIP staff via e-mail

to effectively recognize outstanding performance