Immunization Information Systems: One Foundational Data Source, Endless Health Insights

July 22, 2025 | Kim Martin, Mary Beth Kurilo

A Bold Vision

Back in 2014, a state health official from the Midwest recognized a problem: immunization information systems (IIS) were jurisdictionally based — mostly at the state level — resulting in data gaps when people moved or received care across state lines. In talking with his ASTHO colleagues, he shared a bold vision: what if ASTHO led a coordinated effort to unite key stakeholders and make widespread, seamless interjurisdictional immunization data exchange a reality? Momentum built quickly, and by the end of the year, ASTHO had convened a broad coalition of stakeholders and meaningful progress followed:

• A draft memorandum of understanding (MOU) to enable data exchange across jurisdictions.
• A community of practice that fostered peer-to-peer learning and problem-solving.
• Stronger support for the development and implementation of the Immunization (IZ) Gateway, a federally sponsored technology solution and infrastructure that facilitates immunization data exchange.

As these efforts advanced, organizations like the American Immunization Registry Association (AIRA), a national nonprofit dedicated to supporting and strengthening IIS, played a growing role in supporting IIS interstate data exchange while continuing to advance data standards, improve data quality, and promote IIS modernization across the country.

Results: Connections Continue to Expand

Today, 57 IIS jurisdictions have signed interjurisdictional exchange MOUs, and 44 jurisdictions are participating in IIS-to-IIS data exchange through the IZ Gateway. Those 44 jurisdictions have connections with their peer IISs for a total of 361 live connections that create pathways for data to securely flow across state lines. Have we completely solved the interjurisdictional data challenge? Not entirely, but we are well on our way to a collaborative solution that addresses a significant proportion of the data gap. As this state health official pointed out, broad collaboration is not only essential to this work — it’s a defining strength of ASTHO, AIRA, and the wider immunization community.

Unprecedented Times

We often hear that we are operating in unpredictable and evolving times. During recent discussions, immunization program staff highlighted potential risks to immunization infrastructure, particularly IIS, due to cuts in federal funding. With funding winding down, jurisdictions are anticipating impacts such as staffing reductions, the loss of contracted support, and the slowing or halting of ongoing data modernization work. These systems are important not just for supporting routine immunization efforts, but also for readiness in future outbreak or emergency responses. As the funding landscape continues to evolve, it's important to highlight the central role IIS play in providing timely, high-quality data to a wide range of stakeholders, including:

• State, tribal, local, and territorial health departments, which use IIS data to monitor coverage rates, manage vaccine ordering and inventory, and support reminder/recall efforts.
• Health care providers, who access IIS through bidirectional connections with Electronic Health Records or pharmacy systems to deliver informed care at the point of service.
• Long-term care and skilled nursing facilities, which serve vulnerable populations and depend on complete immunization histories for residents.
• Educational institutions — including colleges, secondary schools, and childcare centers — that verify student immunization status during enrollment.
• Health payers, who enhance claims data with IIS records to improve Healthcare Effectiveness Data and Information Set reporting and member outreach.
• Federal partners, who use IIS data to support nationwide surveillance and response efforts.
• Individuals and families who are increasingly empowered to access their own immunization records for health care, school, travel, and personal use.

Immunization data is undeniably a vital resource that supports and strengthens both public and private health systems, helping keep communities healthy and ensuring we are better prepared for the next outbreak or pandemic.

Where Do We Go Next?

Broad interjurisdictional exchange of immunization data started with a vision from a single state health official. What can we tackle together next?

• Advocate for sustained IIS funding through public/private partnerships — We need to consider new funding models for IIS. With so many partners valuing and benefiting from IIS data, we have a rich resource to protect and support together. We could look to key partners (CMS and private payers, large health systems, EHR vendors, pharmacies) to support the systems and programs that ensure the secure exchange of immunization data.
• Support ubiquitous consumer access — All individuals can benefit from convenient and efficient access to their own and their family members’ immunization records to manage their health, inform their health care decisions, or supply documentation for work, travel, or school/childcare requirements. Today, only about half of the United States has direct consumer access to their immunization record in the IIS.
• Encourage broad IIS participation — We can all actively promote policies or incentives that encourage authorized health care providers and partners to exchange data with their IIS. However, not everything needs to be a formal law or policy. Sometimes, simply fostering a culture of routine reporting to or querying the IIS as the standard of care can make a meaningful difference. It’s also important to ensure onboarding processes are efficient and that providers and partners receive the necessary technical support.
• Ensure legal and policy support for your IIS — Advocate for laws and regulations that support provider reporting, data sharing, and patient access while safeguarding privacy. Address barriers such as consent requirements that may add burden to providers and limit comprehensive data collection.

Together, we can ensure that IIS are robust, reliable, and an integral part of immunization programs and the broader public health infrastructure. By strengthening these systems, we help ensure individuals receive high-quality, personalized care — wherever they are.