While the government has been the major buyer of vaccines, the proposal would change its role to assuring that everyone receives them, including a subsidy for health plans and providers.
"We offer a plan that both ensures access to vaccines for those in need and creates incentives for private investment in the vaccine industry that would sustain the development and manufacture of these products in the future," said Frank Sloan, professor of health policy at Duke University and chairman of the Institute of Medicine panel that issued the report.
Walter Orenstein, director of the National Immunization Program at the Centers for Disease Control and Prevention, welcomed the report, saying it provides many useful suggestions and recommendations that will be considered by his agency.
Mark Pauly of the University of Pennsylvania, a member of the committee that prepared the report, said: "We wanted to design a system where access and availability isn't something that occurs only if you're lucky."
Just last week the CDC reported that just 75 percent of the nation's toddlers get vaccinated on schedule against nine different diseases.
Coverage varies widely among states and major cities, CDC said, with pockets of the country where far too few youngsters are up-to-date on their shots. Federal health officials urged communities to eliminate those disparities.
The CDC, which had requested the study, declined immediate comment on its suggestions.
Currently the federal government spends about $1 billion annually to buy about half of childhood vaccines, which are primarily distributed through the states in programs such as Medicaid and Vaccines for Children. Additional money is also spent for some adult vaccines.
But a reduction in the number of companies producing vaccines has helped lead to shortages in the last couple of years. CDC has said it plans to establish a vaccine stockpile by 2006 to avoid such problems in future.
Offering a subsidy for the purchase and distribution of the vaccines would also provide a stable market, encouraging manufacturers, the report said.
It noted that there were more than 25 companies producing vaccines for the U.S. market 30 years ago, while only five do so today.
While most health plans already cover vaccines, the report recommended changes in federal regulations to make sure all do so.
The panel recommended that both government and private health plans be required to cover vaccinations for all insured children, adults aged 65 and over and people who have health disorders that place them at higher risk for vaccine-preventable disease.
Vouchers for uninsured people in those categories would allow them to obtain the same protection.
How the changes would affect the amount of federal spending on vaccines was not immediately clear, although the report said it was likely to increase because more people would be eligible for subsidized shots.
But it noted there are also benefits to society of getting more people protected from disease, both in avoiding them being sick but in also not infecting others.
Getting the government out of the position of being the largest vaccine buyer would avoid the delays now associated with contract negotiations, price caps, funding cycles and discount arrangements, the report said.
The Institute of Medicine, a sister organization to the National Academy of Sciences, is a private organization that provides advice to the government on scientific issues.