INTRODUCTION -- Background -- Conceptual framework for the study -- Study process -- Summing up -- Organization of the report -- ORIGINS AND RATIONALE OF IMMUNIZATION POLICY -- Legislative history of vaccine policy -- Shared federal and state responsibility for financing -- Shared public and private responsibility for coverage -- Public and private delivery systems -- Private vaccine production -- The setting national of vaccine policy -- Findings -- PUBLIC AND PRIVATE INSURANCE COVERAGE -- Public insurance coverage -- Private insurance coverage -- Barriers to a well-functioning immunization finance system -- Findings -- THE DELIVERY SYSTEM -- Delivery of adult and childhood vaccines -- The work of immunizing -- Provider reimbursement -- Barriers to a well-functioning immunization delivery system -- Findings -- VACCINE SUPPLY -- Size and growth of the vaccine market -- Vaccine production -- Cost structure -- Research and development -- Industry concentration -- Regulation -- Pricing -- Shortages -- Stockpiles -- CDC contracting -- Barriers to a well-functioning vaccine supply system -- Findings -- CONCLUSIONS AND ALTERNATIVE STRATEGIES -- Conclusions -- Alternative strategies -- Weighing the alternatives -- RECOMMENDATIONS -- Final observations