This book is the Institute of Medicine's response to the first part of the statement of task asking for a review of the 1994 National Vaccine Plan. The Committee on the Review of Priorities in the National Vaccine Plan reviewed the goals, objectives, strategies, and anticipated outcomes presented in the plan; their findings are contained in this book. In the first section of the book, the committee examines what has changed in the broader social, policy, and economic context of vaccine development and immunization, and highlights several areas where noteworthy progress has been made, particularly by federal agencies. The committee acknowledges that progress in developing and delivering vaccines has benefited from essential contributions by other stakeholders, including researchers, manufacturers, state and local public health agencies, and health care providers. In the second section of the book, the committee uses what it learned from reviewing the 1994 plan and the process of preparing it to distill key elements. Based on these elements, the committee offers guidance to NVPO and its partners on developing the update to the national vaccine plan.