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Wed Jun 9 12:57:19 2021
(*5e05c158*):: ACIP does more than simply make recommendations; it wields power beyond its mission, design, or authority. By default, it plays a pivotal role in vaccine policy by determining the market for vaccines, influencing prices, and setting a benchmark of sorts for the cost–benefit threshold for new vaccines. But this is a role for which ACIP may not be particularly well suited because it is not structured to perform such a broad public policy function. ACIP exhibits two principal limitations in this regard. +public!

The successful effort to halt polio epidemics stimulated interest in identifying opportunities to prevent other childhood diseases. In the early 1960s, the Kennedy Administration launched the Assistance Act of 1962, which provided federal support to state and local immunization programs using oral polio *vaccines*, as well as diphtheria, pertussis, and tetanus (DPT) *vaccines*. The legislation established a federal presence in the financing of childhood *vaccines* but not direct purchase.

Beginning in 1965, substantial changes occurred in federal immunization policy that continued over the next decade. The first bulk purchases of *vaccines* under a federal contract occurred in fiscal year 1966, when the federal government purchased polio and measles *vaccines* under consolidated contracts and provided them in lieu of financial grants to state and local public health agencies. The purpose of this policy change was to offset the costs incurred by state and local public health agencies, since the bulk purchase of *vaccines* under a federal contract led to substantial price reductions. Additional *vaccines*, including the rubella and combined measles–mumps–rubella () *vaccines*, were added to the federal *vaccine* contract between 1969 and 1975. Even as late as 1982, however, diphtheria and tetanus toxoids and whole-cell pertussis (DTP) *vaccines* were not being purchased under the federal contract because their prices were low, and limited savings could be achieved by bulk purchases. In addition, Congress enacted  of the Public Health Service Act in 1972 to provide grants to state and local governments for immunization infrastructure development and *vaccine* purchases.