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Childhood Immunizations: Easy Access versus Requirement for Essential Services

Policy Date: 1/1/1991
Policy Number: 9102

9102: Childhood Immunizations: Easy Access versus Requirement for Essential Services

The American Public Health Association,
Recognizing the importance to the health of children and the nation that all children be fully immunized;1 and
Supporting the Year 2000 Objectives to ensure that at least 90 percent of children under age two have received the basic immunizations series;2 and
Knowing that through past resolutions (e.g. No. 78053 and No. 87064), the Association has taken a leading role in supporting universal childhood immunization in the United States and abroad; and
Being aware that the recent measles epidemic is one indicator of the “failure to deliver vaccine to vulnerable preschool children on schedule;”5 and
Being aware of the importance of vaccinating infants against Haemophilus influenzae type b (HIB) disease to prevent death and significant mental retardation;6 and
Noting that the proposed expanded funding for immunizations is still not sufficient to meet current and additional recommended dose schedules for vaccines for measles and HIB;7 and
Noting that more needs to be done to assure that all preschool children are appropriately immunized, including expanding and improving primary care services which is the most desirable approach to immunization and care of children; and
Noting that immunization coverage in developing countries increased from 20 percent to 80 percent between 1980 and 1990, and that WHO, UNICEF and USAID have acquired experience in a number of methods for improving coverage; and
Being aware that proposals have been made to make adequate immunization levels a criterion for enrollment of children in Aid to Families with Dependent Children (AFDC), Medicaid, the Supplemental Food Program for Women, Infants and Children (WIC) services that provide basic life support to vulnerable populations;8 and
Understanding that the children who are eligible for these programs are among the most vulnerable members of our society who require easy rather than obstructed access to services; and
Observing that making immunization a criterion for enrollment is a punitive action which singles out a particular group in the population — which is an inequitable policy; and
Noting that such a policy immeasurably complicates access and serves as an additional barrier to already difficult enrollment into WIC, AFDC, and Medicaid; therefore
1. Urges the US Government and the Congress to discontinue any efforts to make AFDC, Medicaid, and WIC-eligibility dependent on immunization status;
2. Urges the US Government, the Congress, and state and local agencies to explore ways of enhancing access to WIC, AFDC, Medicaid, and immunizations through simplified enrollment procedures and improved integration among programs (one-stop shopping);9 and
3. Recommends that CDC, state and local governments and other US-based agencies examine strategies used by WHO, UNICEF and USAID in developing countries to improve immunization coverage in the United States;
4. Supports continued and expanded funding for the immunization program;
5. Supports provision of lower cost vaccines in the public and private sectors and if low cost vaccines cannot be obtained, government production should be considered;
6. Supports continued and expanded funding and universal financial access to make primary care services available and accessible to all children regardless of income status;
7. Supports legislation to mandate coverage to all recommended childhood immunizations by all third party payers; and
8. Urges the Federal Government to provide resources to support local and state data collection efforts to strengthen reinstating national immunization surveillance.


  1. White CC, Koplan JP, Orenstein WA: Benefits, risks and costs of immunization for measles, mumps and rubella. Am J Public Health 1985;75:739-744.

  2. Promoting Health/Preventing Disease: Year 2000 Objectives for the Nation. Washington, DC: Public Health Service, US Department of Health and Human Services, September 1989.

  3. American Public Health Association Public Policy Statement No. 7805: Immunization against Childhood Diseases. APHA Public Policy Statements, 1948 to present, cumulative. Washington, DC: APHA, current volume.

  4. American Public Health Association Public Policy Statement No. 8706: Universal Childhood Immunization. Op Cit.

  5. The Measles Epidemic: The Problems, Barriers and Recommendations. Atlanta: National Immunization Practices Advisory Committee, Centers for Disease Control, January 8, 1991.

  6. H. Influenza Vaccine for Infants. Medical Letter on Drugs and Therapeutics, Vol. 33, January 25, 1991.

  7. American Academy of Pediatrics: Government Activities Report. Washington, DC: AAP Legislative Office, March 1991.

  8. The New York Times, November 29, 1991.

  9. Macro Systems, Inc: One-stop shopping for perinatal services: Identification and assessment of implementation methodologies. Washington, DC: National Center for Education in Maternal and Child Health, 1990.