The Universal Purchase (UP) program, adopted by many states in an attempt to further increase vaccination rates, may be ineffective, according to a study published in Vaccine.

Due to vaccines’ population-level impact on eradicating diseases, federal, state, and local governments have played an important role in their purchase. The Centers for Disease Control and Prevention (CDC)  Public Health Service Immunization Grants Program assists jurisdictions with the purchase of essential vaccines, ultimately increasing immunization rates. Consequently, other federal reforms have had an impact on state-level purchasing power and childhood access to vaccines. For example, the Vaccines for Children (VFC) reform that ensures vulnerable children have vaccine access at no cost has been increasing vaccination rates since 1993.

In addition, in the late 1990s, some states extended this reform to a UP structure with the intention of further increasing vaccination uptake and to reduce the burden on providers who had to finance up-front vaccine costs, including providers who are privately insured.

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Although UP programs were introduced more than 2 decades ago, literature considering their effect on vaccination rates is sparse, with mixed findings. Therefore, this study estimated the association between UP programs and vaccination rates.

Using state- and individual-level data from the 1995-2014 National Immunization Survey, the effect of a state’s UP adoption on children’s (age 19 to 35 months) vaccination rates was estimated.

For both the state- and individual-level analyses, an ordinary least squares regression was used to estimate either the state’s vaccination rate or the child’s likelihood of being vaccinated as a function of whether the state had UP in the given year, state vaccine policies, state/child demographic characteristics, fixed effects, and time trend. Separate regressions for each 9 recommended vaccines (polio, diptheria and tetanus toxoids and acellular pertussis (DTaP/DT/DTP); measles or measles-mumps-rubella (MMR); hepatitis A (HepA); HepB; Haemophilus influenzae type B (Hib); varicella; pneumococcal conjugate vaccine (PCV); and rotavirus) were performed, as were composite measures on whether a child was up to date on all required vaccines.

UP was found to have an insignificant effect on any vaccine or composite measure. At the state level, using DTaP as an example, a state without UP had a vaccination rate of 83.8%, while the rate was 83.3% in the same state with UP (P >.10). In a similar fashion, a child had a 96% chance of being vaccinated in a non-UP state and a 97% chance in a UP state (P <.10).

Furthermore, UP programs had an insignificant effect on vaccination rates for any of the vaccines studied, except varicella in 1 specification, translating to a 1.2% increase. Finally, UP had an insignificant effect on the percentage of children who are up to date for the 5-series, and are only significant for the 6-series and 7-series in certain specifications (P <.10).

Conceptually, these results make sense since UP programs target a subset of the population that is not VFC-eligible. Overall, the study investigators concluded that, “Although UP programs are financed through fees imposed on insurance providers and therefore may be relatively low-cost policies to implement from a state budget perspective, policymakers who want to increase vaccination rates will need to consider policy solutions other than UP programs.”


Please refer to full-text reference for list of author disclosures.


Mulligan K, Snider JT, Arthur P, et al. Examination of universal purchase programs as a driver of vaccine uptake among US states, 1995-2014. Vaccine. 2018;36:4032-4038.

This article originally appeared on Infectious Disease Advisor