Insofar as a number of extraordinary expenses were incurred in fiscal 1995, CDC officials anticipate that final survey costs will decrease in fiscal 1996 and future years. For the calendar year 1994 survey, contractors estimated that the overall response rate was 69.5 percent. Identification of Pockets of Need

CDC officials have indicated that they view identification of pockets of children in need of more timely immunization as a state responsibility rather than a federal one. Instead, the primary objectives CDC has for the NIS have been monitoring state progress in achieving childhood immunization objectives, permitting comparison of current coverage rates across states, and awarding incentive funds available to CDC grantees based on their immunization of certain percentages of preschool children. First, of the appropriation that it has requested for fiscal 1997, CDC has requested $16 million for the survey and its administration. Second, the NIS does not provide useful quarterly measurements of statewide immunization levels, and even annual estimates may not be suitable for monitoring the level of annual change that is likely to occur in immunization coverage. Insofar as this indicator is not linked to any specific component of the unique set of immunization initiatives pursued by a particular CDC grantee, it is not surprising that it is not useful in helping states to diagnose problems in their ongoing activities, target their efforts, or design interventions. GAO Comments

1. 2. 3. 4. CDC has acknowledged that the NIS does not identify pockets of children in need of more timely immunization, and most state immunization program managers have told us that the NIS does not help them in targeting their efforts or designing interventions, although it does relieve them of CDC’s previous requirement that they collect statewide coverage data on their own. 6. 7. 13.
Why GAO Did This Study

Pursuant to a congressional request, GAO assessed the Centers for Disease Control and Prevention's (CDC) National Immunization Survey (NIS), focusing on: (1) survey costs; (2) survey methods; and (3) use in identifying groups of children in need of more timely immunization.

What GAO Found

GAO found that: (1) CDC designed NIS for monitoring state progress in achieving child immunization objectives, comparing coverage rates across states, and awarding incentive funds; (2) CDC estimates and contractor invoices indicate that NIS costs for fiscal year (FY) 1995, including extraordinary expenses incurred when 1994 survey participants were reinterviewed, were about $13 million; (3) although CDC anticipates that survey costs will decrease in the future, it has requested $16 million for NIS administration for FY 1997; (4) the two-phase survey methodology, which gathers information by telephone from households and immunization providers, excludes households that lack a telephone, may not accurately represent the overall population, and is limited by response accuracy; (5) NIS has not achieved sufficient precision in its survey estimates to detect modest changes that occur in most coverage levels; (6) CDC considers the identification of groups of children in need of more timely immunization as a state rather than a federal responsibility and has not designed and does not use NIS to make such identifications; and (7) interviews with state officials indicate that NIS is not useful in helping states to diagnose problems in immunization activities, target efforts, or design interventions.