The role of state policies and programs in buffering the effects of poverty on children's immunization receipt

Objectives. This study assessed the influence of public policies on the immunization status of 2-year-old children in the United States. Methods. Up- to-dateness for the primary immunization series was assessed in a national sample of 8100 children from the 1988 National Maternal and Infant Health Survey and its 1991 Longitudinal Follow-Up. Results. Documented immunization rates of this sample were 33% for poor children and 44% for others. More widespread Medicaid coverage was associated with greater likelihood of up- to-dateness among poor children. Up-to-dateness was more likely for poor children with public rather than private sources of routine pediatric care, but all children living in states where most immunizations were delivered in the public sector were less likely to be up to date. Poor children in states with partial vaccine replacement programs were less likely to be up to date than those in free-market purchase states. Conclusions. While state policies can enhance immunization delivery for poor children, heavy reliance on public sector immunization does not ensure timely receipt of vaccines. Public- and private-sector collaboration is necessary to protect children from vaccine- preventable diseases.