Recommendations of the Texas Comptroller

Improve Texas’ Immunization Programs for Children

Summary

Public-private partnerships such as the Seniors and Volunteers Program For Childhood Immunizations (SVCI) use volunteers and community resources to improve immunization rates among Texas children. Such efforts involve outreach work in hospitals and with new mothers, the provision of transportation and other services, and follow-up calls and visits to ensure that children complete their series of immunizations. Texas should expand the SVCI program to reach more children among areas and population groups that have low immunization rates.

Background

To minimize exposure to infections and prevent serious disease, children should receive certain standard immunizations as early as possible. Ideally, by the time they are 15 to 18 months old, children should be vaccinated with four doses of diphtheria-tetanus-acellular pertussis vaccine; three doses of polio vaccine; and one dose of measles-mumps-rubella vaccine. This combination of immunizations is sometimes called the “4-3-1” series.

Yet Texas ranks 47^th among states in the immunization rates of its children. A 1999 survey conducted by the US Centers for Disease Control and Prevention (CDC) found that only 75 percent of Texas children aged 19 months through 35 months had completed the 4-3-1 series of vaccines compared to a national rate of 80 percent (Exhibit 1).[1]

Exhibit 1

Percentage of 4-3-1 Vaccination Coverage Among Texas Children

19 months to 35 months of Age, January 1999 to December 1999, by County

Source: Centers for Disease Control and Prevention.

Obstacles to Improved Immunization Rates

Texas faces a number of obstacles to the effective, universal delivery of childhood immunizations.

Some barriers arise from Texas’ cultural diversity. The children of migrant farm workers, for instance, often do not receive immunizations at the appropriate age. Language barriers and illiteracy contribute to this problem, as well as a general distrust of “authority”; in some cases, uninsured immigrants are reluctant to take their children to public health facilities for fear of jeopardizing their immigration status. Such parents also may not have a single doctor or clinic to serve as their medical “home,” with consistently maintained medical records.[2] In such cases, parents must be made aware of the importance of the full 4-3-1 immunization series. Programs that educate new mothers on the benefits of immunization can help increase immunization rates, as can reminder and recall systems that notify parents when it is time to return for more immunizations.

Texas’ geographic diversity also contributes to these difficulties; some areas simply do not offer easy access to health facilities offering immunizations, while others do not provide them during hours convenient to working parents.

Public-Private Partnerships

Public-private partnerships can help local communities promote awareness of the importance of immunization and fund activities to increase immunization rates. Such partnerships can help communities find local solutions to critical public health concerns. The involvement of local businesses or local professional sports teams, for instance, can be very effective in getting the word about immunizations out to mothers and families. For maximum effectiveness, outreach efforts should target areas and populations with low immunization rates, including inner-city areas, areas of high unemployment, and homeless and migrant families.

Senior and Volunteers for Childhood Immunization Program

One particularly successful local program is the Senior Volunteer Program For Childhood Immunizations (SVCI), an award-winning program administered by the University of North Texas (UNT) and now operating in 11 Texas cities, including Austin, Amarillo, Big Spring, Colorado City, Denton, Dallas, Fort Worth, Levelland, Longview, Sherman, and Temple.

At this writing, SVCI services are provided primarily through the Texas Department on Aging’s Retired and Senior Volunteer Programs (RSVPs), senior centers that offer retirees the chance to participate in various volunteer projects. However, any public, private, or nonprofit organization can qualify to sponsor an SVCI program, including civic organizations, faith-based organizations, local immunization coalitions, and hospitals. SVCI programs are funded by federal CDC grants distributed to the Texas Department of Health, which in turn subcontracts with UNT, as well as private monetary and in-kind donations.

Senior volunteers are recruited at health fairs, volunteer fairs, churches, and through public service announcements. SVCI volunteers visit new mothers to explain the importance of immunizations, spread the word through mailouts and phone calls, and provide transportation to vaccination sites. They explain immunization schedules to parents and make follow-up visits to ensure the completion of the crucial early 4-3-1 immunization series.

UNT establishes new SVCI sites by contacting local RSVPs to see if they are interested in participating. Before receiving funding from the university, each potential site must submit a proposal providing information about its capacity to operate as an SVCI site. Prospective site agencies must provide information about their current funding sources, operational programs, mission statement, staffing, senior volunteer resources, and cultural and ethnic profile. The information then is forwarded to UNT’s School of Community Service for final approval.

Recommendation

State law should be amended to fund and expand the University of North Texas’ Seniors and Volunteers for Childhood Immunization Program (SVCI).

The SVCI program reached about 30,000 children in 1999 with 11 sites in operation. Opening 20 more sites should allow 60,000 more children to be contacted by the program.[3] Texas should support the addition of ten new SVCI sites around the state in each of the next two years.

Fiscal Impact

Startup funding for the creation of 10 additional SVCI sites per year in fiscal 2002 and 2003 would cost the state $500,000 over the biennium. These funds could generate at least $1 million worth of private contributions. The funding should be appropriated to the Texas Department of Health’s immunization outreach program. No additional state employees would be required, although some of the funding may be needed to pay for the University of North Texas’ cost of administering the program. This program is designed so that each site continues operating with private contributions after the first year of operation.

[1] Texas Department of Health, Comprehensive State Plan to Improve Immunization Levels in Texas (Austin, Texas, May 2000), p. 1 (http://www.tdh.texas.gov/immunize/stateplan.htm). (Internet document.)

[2] National Governor’s Association, Monitoring the Health Status of Hard-to-Serve Children: Lessons for SCHIP Implementation (Washington, DC, September 28, 1998) (http://www.nga.org/pubs/issuebriefs/1998/\980928children.asp). (Internet document.)

[3] Interview with Kathy Pettiford, director, Senior and Volunteers for Childhood Immunizations, Texas Institute for Research and Education on Aging, School of Community Service, University of North Texas, December 4, 2000.

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