CDC Shifts Vaccine-Data Focus

"This increase came about as a result of data-driven outreach strategy involving a mobile van and collaboration between clinicians, the city, and the state," he wrote. "Without the survey, Baltimore will lose the best way to measure our continued progress and will have trouble quickly recognizing declining immunization levels."

Duchin said that in Seattle "we've had widely fluctuating rates in the last 10 years of as much as 10 to 13 percent." The data have helped the health department there chart the effects of "parental hesitancy" and other reasons for missed or refused shots, he said.

Anthony Iton, chief health officer for California's Alameda County, which includes Oakland, said authorities there survey children entering kindergarten to get a snapshot of vaccination rates three years earlier, when the children were at the target age for the immunizations. The vaccination schedule, however, changes frequently, as new vaccines are approved and old ones are repackaged into more expensive combination shots.

"We need to know if the new vaccine has helped, or had no change, or hurt [coverage], and we cannot really make those judgments without the NIS data," he said.

CDC officials said they are redirecting about $3 million to survey adolescents. The only way to pay for the 22-city sampling would be to use money now used to help states buy vaccine, they added.

"We didn't want to rob the implementation in favor of the evaluation," Rodewald said.

The decision comes at a time when the government is spending record amounts on public health.

The CDC's budget has risen 42 percent since 2001 and is now $8.73 billion. It rose 23 percent the year after the Sept. 11, 2001, attacks as the government invested $1.1 billion in terrorism preparedness and emergency response.

Public health officials in the 22 cities seem resigned, at least for the moment.

"We're all just hoping that there will be re-prioritization toward some of these core public health programs," said Duchin, the Seattle epidemiologist. "After all, we're not a poor country."