AFIX Chronology

Georgia Department of Public Health implements a statewide program to assess immunization records annually in all public clinics: shown to be effective.

The Georgia Department of Public Health implemented a statewide program in 1986 that consisted of annual assessments of immunization records at its public health clinics.  Information was fed back to clinic providers and their staff who, in turn, developed their own solutions to improve coverage.  Incentives included rank order listings of clinics by coverage level, awards for sites with the highest levels, and presentations by successful clinics at annual immunization meetings.  Other successful strategies included coordinating with WIC, conducting reminder/recall phone activities, and providing performance Feedback to nursing staff.  As a result of these efforts, immunization coverage levels in Georgia public clinics increased from 40% to 91% between 1986 and 2001.

Measles resurgence 1989–1991

Major cause: missed opportunities to vaccinate

National Vaccine Advisory Committee (NVAC) "White Paper" about problems that led to the measles epidemic and recommendations. Recommended immunization standards including simultaneous administration; recommended "projects to improve immunization coverage."

Childhood Immunization Initiative (CII):

Major goal: to achieve 90% coverage for preschool children. CII included six components including the creation of the VFC Program and AFIX.

To remedy this situation, the Department of Health, Education, and Welfare (now Department of Health and Human Services) announced, on April 6, 1977, a nationwide Childhood Immunization Initiative. The Initiative had 2 stated objectives: 1) To attain immunization levels in the nation's children of at least 90% by October 1979. 2) To establish mechanisms to maintain high immunization levels by ensuring that children received vaccinations at the proper times.

Congress directs CDC to develop guidelines for assessing immunization rates in public clinics.

CDC was tasked to ensure that all States receiving Section 317 Immunization infrastructure/operations grant funds conduct annual provider Assessments in all public clinics using a CDC-approved methodology now known as Assessment, Feedback, Incentives, and eXchange of Assessment information (AFIX). 

ACIP recommends Assessment & Feedback at all provider offices. CDC grantees required to conduct annual Assessments in public clinics.

The Assessment visits were instituted in public sector clinics to improve immunization practices and coverage rates.

NVAC report (JAMA) recommends Assessment & Feedback

Review of the evidence by the Task Force on Community Preventive Services: Assessment and Feedback “strongly recommended”

The National Vaccine Advisory Committee (NVAC) recommended that all immunization providers, both public and private, should have their vaccination coverage levels assessed annually, and that private providers should be assisted in this effort by state and local health departments.   This recommendation provided support to implement AFIX in private provider settings, in addition to the public health clinic settings where AFIX was primarily conducted.

VFC-AFIX established

The separate initiatives (VFC and AFIX) were combined to allow the programs to achieve a broader reach among both public and private providers. The joining of the VFC and AFIX programs was initiated in 2000, and supplemental funds were awarded to 37 grantees to support a combined VFC-AFIX initiative. Currently, 61 grantees receive VFC-AFIX funding.

Assessment and Feedback listed as one of the 17 "Standards for Child and Adolescent Immunization Practices"

Task Force updates 1999 review; affirms previous recommendation