Although 95% of children have had a full course of vaccines by the time they enter school, immunization levels among poor inner-city preschoolers may be substantially lower. Among the factors responsible for the disparity are the lack of a uniform data system to identify children who need vaccine; missed opportunities to offer immunizations; overinterpretation of contraindications; and administrative barriers to immunization. Remedies lie in a multifaceted approach: a tracking system that will prompt a reminder and then sound an alarm when an immunization is overdue; means of informing parents, probably best accomplished by an outreach worker of the same racial or ethnic background as the parent; removal of administrative barriers and increased access to services; incentives, either positive or negative, to raise the priority of immunizations; and more education for health care providers to ensure that they understand contraindications and do not miss opportunities to offer vaccines. Other possibilities are "express lane" services to immunize all children who come to a health care provider and the delivery of immunizations in child care settings and in programs such as Women, Infants, and Children, and Aid to Families With Dependent Children.
