Policy and Position Statements


Immunization Policy Statement

Immunization is a vital public health tool and one of the most cost-effective means of public health promotion and disease prevention. Vaccines prevent disease, disability, and death in children and adults. Sustaining high vaccine coverage levels in children and adolescents, increasing coverage rates in adults and incorporating new vaccines into the routinely recommended immunization schedule require vigilance and adequate resources.

To support the nation’s immunization system, ASTHO supports:

  • Incentives and policies to encourage vaccine development and ensure a stable, adequate and safe vaccine supply.
  • Enhanced, stable funding to support public health infrastructure for immunizations to ensure timely and safe delivery of vaccines in the public and private sectors.
  • Research to ensure the safety of vaccines, to evaluate the effectiveness of vaccine delivery strategies and to better understand the transmission of disease and vaccine hesitancy.
  • The National Vaccine Plan and its implementation.
  • State and territorial flexibility to tailor the implementation of evidence-based strategies for increasing vaccination uptake and reducing vaccine hesitance to meet the needs of local and regional populations.


  1. Enacting vaccine requirements for school and day care entry is a state and territorial responsibility. States and territories should individually consider vaccine laws and regulations and employ a rigorous decision-making process that is evidence-based and seeks the input of experts and the public. School and child care requirements for any vaccine must be pursued through existing state and territorial processes. To enhance current immunization initiatives within this population, states should consider innovative strategies in both preschool and day care settings.
  2. It is the right of states to pursue appropriate policies and legislation; however, the adoption of easy-to-attain exemptions to vaccine requirements is inconsistent with good public health policy and contrary to efforts to improve vaccine coverage.
  3. The development of immunization laws and reporting should be based on and reflect recommendations made by the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices.


  1. States have primary responsibility for implementing grant activities and policies and ensuring that quality assurance and vaccine accountability systems are in place in publicly funded vaccine programs.
  2. A careful balance between program requirements, reporting requirements and maintaining provider participation is needed.


  1. Cost should not be a barrier to immunization. ASTHO encourages insurers to provide full, first-dollar coverage for immunizations recommended by the Advisory Committee on Immunization Practices or required by state and territorial law throughout the life-span.
  2. ASTHO supports adequate funding of public programs to strengthen the infrastructure necessary for a vaccine delivery system, meet the increasing cost of vaccines and provide safety-net coverage for those without adequate health care coverage.
  3. Vaccines should be accessible by all populations in all possible settings. ASTHO supports providing immunizations to all those who have inadequate health care coverage for immunizations.
  4. Vaccine financing policies should recognize the value of vaccines and provide adequate compensation for vaccines and vaccine delivery, as well as incentives for continued vaccine research and development.
  5. ASTHO supports development and maintenance of vaccine stockpiles to ensure adequate supplies and encourages vaccine rotation and extended product shelf-life without compromising product stability and efficacy, to ensure no vaccine is wasted.
  6. Vaccine billing systems should allow states and localities to bill well-insured children, adolescents and adults served in the public sector.


  1. Federal, state, territorial, tribal and local public health agencies and public and private providers all play a vital role in immunization. ASTHO supports evidence-based strategies to improve and sustain immunization coverage levels that can be adapted to state, territorial, tribal and local needs.
  2. ASTHO supports basing health policy decisions and immunization goals on the most comprehensive data available, including use of multiple national surveys. The National Immunization Survey (NIS) is the most cost-effective tool currently available for measuring state-by-state and territorial vaccine coverage levels and needs enhanced federal funding to measure coverage levels for the expanded child and adolescent immunization schedule. ASTHO supports timely release of data from the NIS.
  3. Children and adolescents should receive immunizations in the setting that is linked to their primary health care. Often the optimal location for immunization is the medical home. Recognizing that every child may not be reliably linked to a health care provider and broad vaccination recommendations may make it less feasible to receive vaccine in one’s medical home, state, territorial, tribal and federal officials should partner with and support other suitable alternative venues for vaccination.


  1. The Section 317 grant program of the Public Health Service Act and the Vaccines for Children program must be adequately funded to provide vaccine for those without health care coverage and those whose health care coverage is inadequate. These programs are critical to our nation’s public health infrastructure.
  2. Federal funding for immunization programs should be distributed to state, territorial, and local grantees in the most equitable manner, with recognition that existing programs should not be weakened. Funds should be distributed based on four criteria: need, capacity, performance, and population, according to a methodology developed with state and territorial input.


  1. Strategies to improve and sustain adult and adolescent immunization should be employed in every state and territory.
  2. Targeted interventions and tailored programs should be used to reduce disparities in coverage rates.
  3. ASTHO encourages research to determine optimal adult and adolescent coverage levels for newly recommended vaccines and to assess the barriers to reaching optimal levels. These data should be used in the development of programs and interventions to improve adult coverage levels.


  1. ASTHO supports periodic reassessment of the National Vaccine Injury Compensation program and the Vaccine Injury Table to determine their adequacy and appropriateness and maintains that any changes should be made in consultation with the states. Information explaining the risks and benefits of vaccine and the availability of compensation for vaccine-related injuries must be developed by the federal government and distributed through effective and appropriate education efforts by all entities and providers delivering vaccine and must be made available in a timely manner.
  2. Risks associated with vaccines must be kept to a minimum. ASTHO supports continued study of vaccines and the development of safety improvements in vaccines and vaccine delivery techniques.
  3. Development of appropriate vaccine safety and risk communication messages should be a priority for the federal government. ASTHO supports continued emphasis on this increasingly important area of vaccine delivery.


ASTHO encourages federal, state, and local public health agencies to work together to advance national security goals and address public health risks by formulating policies that include the vaccination of certain populations for a potential bioterrorism attack. ASTHO supports implementation of bioterrorism preparedness vaccination programs that include:

  • Clear communication of the risks and benefits of vaccination.
  • Clear communication of the most recent threat analysis for the organism in question.
  • Liability protection for those administering the vaccine.
  • Compensation for injuries caused by the vaccine.
  • Standard consent and data collection forms when and where feasible, and under certain warranted emergent circumstances, use of Emergency Use Authorization provisions as provided for by federal statute.
  • Additional resources and funding flexibility.


  1. Vaccine must be effectively allocated, distributed and administered.
  2. Federal, state, territorial, local and tribal governments must collaborate to develop an effective and coordinated pandemic vaccination plan.
  3. Recognizing that vaccine may not be immediately available to everyone during an influenza pandemic, ASTHO supports vaccine targeting to maintain security, health care, other critical infrastructure and essential community services and to protect at-risk populations and workers at occupational risk of infection with the ultimate goal of immunizing everyone who chooses to be immunized.
  4. ASTHO supports the development of guidance on the allocation and targeting of pandemic influenza vaccine that is evidence-based and reflects input from the government, stakeholders and the general public.
  5. The needs and capacities of states and territories differ. Therefore, ASTHO supports flexibility so that the implementation of a pandemic response plan and vaccine targeting guidance may be tailored to meet the specific needs of local and regional populations.
  6. Vaccine availability and planning should include access to a vaccine supply so that state, territorial, local and tribal governments are able to provide an appropriate response to a “routine” outbreak of a vaccine-preventable disease.


Immunization information systems (IIS) are confidential, computerized systems that contain vaccination histories and provide authorized providers immediate access to children’s and adults immunization status. The benefits of IIS include improved office efficiency, reduction of over-immunization, integration of additional public health services, and easier identification of persons at risk in the event of a disease outbreak or other public health emergency.

  1. ASTHO supports and encourages the development, continued use, and further improvement of IIS to assist in integrating several program strategies, including vaccine management, accountability, quality assurance and delivery, consumer information, surveillance, adverse events tracking and assessment.
  2. ASTHO supports the IIS information exchange between authorized users in different states and localities. The ability to share information is especially vital during a public health emergency. After Hurricane Katrina, information exchange enabled displaced children to start school and avoid unnecessary repeat vaccinations.
  3. ASTHO supports the integration of IIS with electronic health records (EHRs) to facilitate information exchange between private providers and public health.

Approval History:

Infectious Disease Policy Committee Review and Approval: September 2011
Board of Directors Review and Approval: October 2011
Ratified by the ASTHO Assembly of Members: December 2011
Policy Expires: December 31, 2014

ASTHO policies are broad statements of enduring principles related to particular policy areas that are used to guide ASTHO’s actions and external communications.

Related ASTHO Documents:

Policy Statements:
ASTHO General Policy Statement
Infectious Disease Policy Statement