Increasing Childhood Immunization Coverage by Improving the Effectiveness of Primary Health Care Systems for Children

PEDIATRICIANS AND other child health care professionals can act to raise the low levels of immunization coverage of US children. At the end of the 1980s, the range of coverage was only 11% to 60%¹ in several major US cities, and the result was the largest measles epidemic since the early 1970s.² By comparison, European countries like the Netherlands, Denmark, and Norway report rates of coverage of more than 80%,³ and even most developing nations exceed US levels after a decade of active, expanded programs on immunization.⁴

While childhood immunization coverage has received a great deal of attention from the Clinton administration, Congress, and advocacy groups, their policy formulations have not always been based on a sound empirical diagnosis of problems or solutions. We need to understand the key determinants of the low level of immunization coverage to develop strategic approaches to resolving the problem. While