Doctors Incentivized by CDC to Increase Vaccination Coverage

Doctors Incentivized by CDC to Increase Vaccination Coverage

doctor with medical form and patientStory Highlights
  • The CDC administers a program known as AFIX to push health care providers to raise coverage rates among children and adults with all federally recommended vaccines.
  • A centralized surveillance database known as Immunization Information Systems (IIS) is the cornerstone of this program.
  • IIS encourages competition among staff by providing incentives and rewards for those who increase the vaccination rate the most.

Many people have encountered going to their physician’s office or their child’s pediatrician’s office and being coerced into “getting up-to-date with their shots.” This is not a rare or random occurrence. There is a method and approach that federal health officials expect health care providers to enforce in order to ensure that vaccination coverage goals are met at the local level.

CDC’s AFIX Approach to Increasing Vaccination Coverage

In 1993, the U.S. Centers for Disease Control and Prevention (CDC) began a program for health care providers known as Assessment, Feedback, Incentive and eXchange (AFIX).1 The purpose of the program is to enlist health care providers to improve service delivery of federally recommended vaccines and increase vaccination coverage levels by identifying areas of low vaccine uptake and improving delivery practices.1 The following is a brief description of the four components of the AFIX program:

The assessment component is the first step to evaluating the health care provider’s immunization records for children up to the age of 18. The CDC executes the assessment phase.

The goal of this stage is to identify opportunities for improving vaccine coverage levels and reducing missed vaccination opportunities.2 The CDC defines a “missed opportunity” as a healthcare encounter in which a person is eligible to receive a federally recommended vaccine but does not receive the vaccine.”3

The CDC expects health care providers to enter all vaccine records into the Immunization Information Systems (IIS), which is the CDC’s main source of data for assessment of vaccine coverage levels in the U.S. IIS is a national electronic vaccine surveillance tool and its functionality continues to expand.

The CDC states:

Population-based IIS will be the cornerstone of the nation’s immunization system. Responsibility for IIS development rests with state and local communities, with assistance from federal and state agencies, and private partners. With the increased IIS functionality comes the ability to execute population-based Assessments, utilize a Geographic Information System (GIS), and provide real-time interface with other data systems. This functionality and interface can streamline the process for Assessment of immunization coverage2

In addition, the CDC website notes:

An IIS provides a single data source for all community immunization providers, enabling access to records of children receiving vaccinations at multiple providers. It provides a reliable immunization history for every enrolled child and can also produce accurate immunization records if needed for school or summer camp entry.3

The CDC also utilizes computer software known as Comprehensive Clinic Assessment Software Application (CoCASA) that…

provides detailed reports on the specific diagnosis of the problem, for example, whether children start their series on time, whether and when patients drop out of the system, and whether vaccines are given simultaneously. CoCASA can also help to raise awareness on issues such as record keeping and documentation and the need for reminder and recall systems.2

This indicates that a centralized national electronic medical/vaccine record keeping system is being operated by the CDC and that a patient’s medical records, including vaccination history, is now or will be readily available to all health care providers, hospitals, federal and state government agencies, schools, etc.  This has serious implications for medical privacy, exercise of medical informed consent rights and the potential for abuse of personal information by social service and law enforcement agencies, as well as doctors discriminating against children and adults who have not received every federally recommended vaccine.

After the assessment is completed, the feedback process begins. It involves informing vaccine providers and their staff, including frontline staff such as clerical staff and office managers, about observations and results from the assessment. The observations include quality improvement strategies, patient dropout rates, missed opportunities and what CDC officials consider to be the inappropriate use of contraindications.2

Once the feedback is provided to health care providers, the incentives component comes into play. It involves techniques and strategies aimed to encourage staff and clinics to improve their vaccine provider services with the ultimate purpose of increasing compliance with use of all federally recommended vaccines.4 The CDC states:

While most health care professionals are motivated by an intrinsic desire to improve health care, extrinsic rewards, or incentives, are often helpful. An incentive is something that incites or has a tendency to incite determination or action. Often times, incentive programs cannot only help providers move forward in achieving their immunization goals; they can also enhance performance over time.2

The incentives are categorized into informal and formal.4 Informal incentives are less costly and include letters of recommendation, free vaccination information materials, etc.

Formal incentives are more lucrative, complex and costly.2 These include grants, scholarships and promotions of clinics as “Immunization Champions”, etc.4 The organizations that sponsor these incentives include coalitions promoting mandatory vaccination, medical trade associations, managed care/HMOs and vaccine manufacturers,2 many of whom have potential conflicts of interest.

The last stage involves the exchange of information necessary to raise vaccine coverage levels.2 This stage goes hand in hand with other incentives. The CDC follows up with health care providers to share information on how their practice’s vaccine coverage status compares to state norms and other vaccine providers in their local area. Information is also exchanged on vaccine compliance strategies that have been successfully used by other providers.4

CDC’s Recommended Strategies for Reducing Missed Opportunities

According to the CDC, several studies have shown that eliminating missed opportunities has the potential to increase vaccination rates by 20 percent.4 There are a number of strategies that CDC encourages vaccine providers to use to avoid “missed opportunities” for vaccination, which include:

  • Reminder and recall messages to patients.4
  • Improving provider education on the principles of vaccination and vaccination scheduling.4
  • Abiding by standing orders. The CDC defines standing orders as protocols whereby non-physician immunization personnel may vaccinate clients without direct physician involvement at the time of the immunization. Standing orders are implemented in settings such as clinics, hospitals, and nursing homes.”4

It is important to understand the aggressive strategies that health care providers are being taught to use to increase use of all federally recommended vaccines. Regardless of what vaccination or other health care choices you make for yourself or your family, it is so important to take the time to become fully informed about all the risks involved and defend your right to make a voluntary decision. It is your basic human right.


1 Centers for Disease Control and Prevention. Overview of AFIX. National Center for Immunization and Respiratory Disease Dec. 10, 2014.
CDC. The Four Components of AFIX. National Center for Immunization and Respiratory Disease Dec. 10, 2014.
CDC. Immunization Strategies for Healthcare Practices and Providers. National Center for Immunization and Respiratory Diseases.
. Assessment, Feedback, Incentives eXchange Program (AFIX) Policies and Procedures Guide. U.S. Department of Health and Human Services.

17 Responses to "Doctors Incentivized by CDC to Increase Vaccination Coverage"

  1. Michelle   August 11, 2016 at 3:56 pm

    Here in Minnesota where there is lots of HMO’s I have seen this a lot. I suggest to patient they see Family Practice Physicians rather than Pediatricians if they are concerned about vaccinations. Less often incentives are placed on Family Practice MD’s about vaccinations they are usually related to diabetes, smoking rates etc. It has been my experience as a provider that Family Practice MD’s are way less ‘pushy’ about vaccinations.

  2. Celeste   August 11, 2016 at 4:14 pm

    This is bad. I don’t have a good feeling about all the vaccinations being mandated. It feels like the world is experiencing some sort of twilight zone era where governments are pushing an untold number of vaccinations, and stripping citizens of their rights all over.

  3. chemfreemom   August 11, 2016 at 6:51 pm


  4. Rebecca Fisher   August 12, 2016 at 4:31 am

    This is great news. Anything that increases vaccination uptake can only be a good thing.

    • CATRYNA WHITE   August 12, 2016 at 6:53 am

      Not really. When they have to use stalking, intimidation, scare tactics and ridicule to get patients to comply, something is definitely amiss! Those techniques spell a battle of forced agenda, not mutual respect between individuals.

    • TeeJae   August 12, 2016 at 8:24 am

      Sure, if you consider vaccine injuries and deaths to be “a good thing.”

    • Chris   August 12, 2016 at 5:13 pm

      You need to do your research from non-mainstream media and talk to the victims of vaccine death and disability. Ignorance may be bliss for you, but I pray you do your research before you put your baby in line for the vaccines they’d love to inject in him or her.

    • Wilma Ralls   August 14, 2016 at 2:52 pm

      You are truly an idiot, especially in not recognizing that no one here is going be accepting of your remark! After all WE ARE ALL suffering from vaccine injury!!!

    • Lois   September 8, 2016 at 5:26 pm

      Rebecca educate yourself and look under the covers. Seriously, do you really trust our government to be looking out for your welfare?? If so, you have to be the last one standing in the face of the constant and ongoing corruption. We, the public are nothing more than a dollar sign to be exploited and field tested upon. Wake up!!

  5. CATRYNA WHITE   August 12, 2016 at 6:50 am

    It’s only August and already I have started receiving notices in the mail, my email and text messages, from my insurance and my doctor’s office, to come in and get the Flu shot, Pneumococcal shot, etc. They are frigging stalkers. I just delete, delete, delete. When the phone calls start, I will just shine them on and hang up. Such jerks.

  6. CJ   August 12, 2016 at 2:04 pm

    The problem with this strategy is that informed consent is often not being fully given if at all as to the dangers to some people of our vaccine schedule. The very fact that there has never been a study comparing fully vaxxed vs never vaxxed is enough evidence that we are not being given full informed consent. And then when you add in the coercion that this kind of “incentive” program encourages, it really spells trouble.

  7. Frank   August 13, 2016 at 9:50 pm

    It’s just another push by big pharma! Greasing pockets as usual..we either give in and be the puppets they want us to be so they can make more money at our expense or we can fight to the end…I choose to fight! If it’s not pharmaceuticals it’s oil…we are always being lied to while these monster companies keep getting richer! If you are in favor of being forced to put a chemical in your body you need to read more unbiased literature. Then you can form a more educated opinion. If you are not open minded you will remain brainwashed by our crooked medical society into believing we are protecting ourselves! I have news for you…we’re not! Remember the “swine flu”? What a joke!!! The first year that came out they made everyone believe we were going to die, spraying live virus up childrens noses…what friggin malarkey that was! A fraction of people died from that as supposed to the regular flu that year. And of those people that died from both types of flu were medically compromised people to begin with…they fail to mention that! My whole family and I got the flu this past winter…It sucked!! But no one died!! We are healthy people that eat well and stay active..try that instead of “thinking” you are protected by some ridiculous vaccine! I could go on forever…

  8. Lois   September 8, 2016 at 5:33 pm

    I’m with you Frank. Years ago we felt sorry for certain countries that spewed propaganda and now it’s in our own borders. We are the ones to feel sorry for now. It would take very little reading and good old common sense to see this monster. Our people have became lazy, it’s easier to drink the Kool-Aid and go about their day.

  9. Robert L . Wachsmuth sr .   February 16, 2017 at 9:20 pm


  10. Colorado   February 17, 2017 at 1:50 pm

    Well, we’re already excluded from just about every youth based state sponsored activity which our tax dollars pay for. In Colorado we cannot find any city programs or popularly advertised non school based activities for youth which do not require us to be big pharma profit dangerous product vaccine compliant. Discrimination would be another accurate description for developing tools which segregate people whom make independent medical choices.

  11. RICK   February 17, 2017 at 2:24 pm

    with vaccines everyone are becoming migets

    • Samantha   February 19, 2017 at 11:20 am

      After already having one autistic grandchild, now their Dr informed them they will no longer be treated by him if they refuse to get the vaccines! Poor kids out there!


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