The national immunization system has achieved high levels of immunization, particularly for children, but faces new challenges, including: continued disparities in immunizations across geographic and socioeconomic populations; recent, unprecedented vaccine shortages; a diminishing number of vaccine suppliers; erosion and fragmentation of insurance coverage for immunization; and concerns about the level of private investment in both current vaccine production and future vaccine development.  
 
Financing Vaccines in the 21st Century: Assuring Access and Availability addresses these challenges by proposing new strategies for assuring access to vaccines and sustaining the supply of current and future vaccines. 

The report proposes a federal mandate, subsidy and voucher program for vaccines.  The mandate would require all insurance plans to include vaccine benefits.  The federal government would subsidize health plans and providers for the purchase costs and administration fees created by the vaccine mandate.  Uninsured individuals would receive a voucher that could be used to receive immunization from any provider.  The subsidy would be based on the societal value of vaccines and would be set in advance for vaccines not-yet-licensed, creating an economic incentive for their development. 

The report recommends changes to the Advisory Committee on Immunization Practices (ACIP), the entity that currently recommends vaccines, and calls for a series of public meetings, a  post-implementation evaluation study, and development of a research agenda to facilitate implementation of the plan.