Measuring the Success of the US COVID-19 Vaccine Campaign

It's Time to Invest in and Strengthen Immunization Information Systems

Jade Benjamin-Chung, PhD, MPH; Arthur Reingold, MD


Am J Public Health. 2021;111(6):1078-1080. 

Policy Reform and Increased Funding

The solutions for strengthening IISs are clear: policy reform and increased funding. IISs are governed by over 984 federal, state, and local policies in 13 areas of law.[2] This often overlapping and contradictory hodgepodge of regulations creates confusion and hampers IIS effectiveness. The CDC, ACIP, and National Vaccine Advisory Committee provide best practices and guidance for IIS managers, but we need to reform laws to make them clear and uniform across all IISs in the following ways.

First, policies to protect patient privacy must be standardized to reduce confusion. Currently, patient privacy protections are specified not only by state and local IIS-specific regulations but also federal laws, such as the Health Insurance Portability and Accountability Act, resulting in confusion. Vaccine providers' liability concerns contribute to inadequate reporting to IISs.[2] Streamlining these policies could thus increase reporting to IISs and protect privacy and public health.

Second, all states need policies authorizing and facilitating data transfers between IISs. Vaccine administration increasingly occurs across multiple localities and states. To accurately capture vaccination in different locations, IISs need to share data across city and state lines, but only about half do so.[2] In some states, IISs do not have the legal authority to share data with other IISs;[3] in others, data exchange agreements are needed to share data, which can slow or prevent data sharing.

Third, policies must encourage rather than hinder IIS innovation. There is no shortage of technological innovations to increase reporting to IISs (e.g., the integration of smartphone apps with IISs, as is done in Canada); however, the complexity of current policies relating to vaccine data privacy and transfer hampers innovation.

Improvements to IISs will require additional funding to support IIS computing infrastructure and staff time. Historically, IISs have been funded by federal, state, and local governments and foundations. Since 2014, the annual federal budget appropriation for immunization programs under Section 317 of the Public Health Service Act has remained the same at approximately $611 000.[7] This pales in comparison with the billions of dollars of federal funding devoted to SARS-CoV-2 vaccine development. The March 2020 Coronavirus Preparedness and Response Supplemental Appropriations Act provided the CDC with $500 million to modernize public health data systems, and the December 2020 coronavirus stimulus bill included $8.75 billion in CDC funding to support COVID-19 vaccine dissemination and measurement of vaccination coverage. However, public CDC documents do not indicate whether any of these funds will be allocated specifically to strengthen IISs. Without increased and sustained funding, IISs will not realize their full potential, even if the policy reforms outlined above are achieved.