Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, March 15, 1993 TAG: 9303150562
SECTION: EDITORIAL PAGE: A-7 EDITION: METRO
SOURCE: C. EVERETT KOOP
DATELINE: LENGTH: Long
CHILDHOOD DISEASES
AT LONG LAST, an administration is coming to grips with the poor immunization record of our youngest children. However, the cost of vaccines is only the tip of the iceberg.The Clinton administration's proposal that the federal government purchase vaccines for all children is a little like a doctor treating the symptoms without trying to cure the disease. The patient may feel better, but the problem won't go away. In the case of America's startlingly low immunization rate among children under 2, the real problem is inadequate public education and access to, not availability of, vaccines.
The generation now having children has little memory of the fear of polio epidemics, nor of the crippling effects of polio on those children who did not die. Nor do they remember the deaths that followed measles and diphtheria. Indeed, many of today's young parents never had these childhood diseases themselves.
Ironically, in conquering these and other potentially deadly diseases of childhood, we have inadvertently created a misplaced sense of complacency about children's health. The fact that as many as half of American children under 2 aren't receiving the necessary vaccinations stems largely from the ignorance of otherwise conscientious, caring and intelligent mothers and fathers. Many parents of preschoolers mistakenly believe that such diseases were eradicated a generation ago. The measles epidemic that swept this country between 1988 and 1991 proves how wrong even people with the best intentions can be.
In advancing a nationalized vaccine-purchase plan, the Clinton administration assumes - erroneously - that the problem is solely economic. True, vaccine prices rose in the 1980s and '90s, when the number of preventative vaccines doubled as a result of new immunization schedules. In addition, largely unfounded fears of severe vaccine-related illness, fueled by media attention, drove up liability-insurance costs for vaccine manufacturers.
However, the experience of 11 states that already have vaccine-purchase plans should be testament enough that universal availability of free vaccines does not guarantee high immunization rates. At an average of only 63 percent, their immunization rates are little better than the national average of 58 percent.
In other states, thanks to a successful private-public partnership, any person - regardless of income level - can have his or her child vaccinated free or on an able-to-pay basis at public-health clinics. Often, private-practice physicians refer their patients whose health insurance (disgracefully) doesn't cover routine childhood immunizations to public clinics. Here, where lines are long and hours short, the deterrent is inconvenience, not expense.
To say that the problem isn't entirely economic doesn't mean that spending more money won't help solve it. However, rather than spending the estimated $300 million to $500 million it would take to buy up the nation's vaccine supply, our resources would be better channeled into a carefully orchestrated effort involving industry and government at all levels.
First, the U.S. Centers for Disease Control and Prevention should increase the number, staff and type of facilities through which government-supplied vaccines are made available. One option is to open additional public-health centers in underserved urban and rural areas and to explore alternative means of delivering vaccines, such as mobile health clinics. Another is to extend the hours of those already in operation to include nights and weekends, when working parents are more likely to be able to take their children for care.
Second, the government should initiate a broad public-awareness campaign using print and broadcast media regarding the need to vaccinate children on schedule, emphasizing the benefits and cost-effectiveness - in terms of disease prevention - of immunization. Expectant parents and parents of toddlers are logical targets for such a campaign.
Third, the Health and Human Services Department needs to develop questions about a child's immunization history and compile information about vaccines and locations of immunization sites, which states could use when enrolling and recertifying individuals in federally subsidized medical programs in order to keep better track of vaccinations. HHS also should require states to develop hospital birth registries, computerized immunization-tracking systems and referral procedures for state-administered programs, as well as a plan for transportation assistance to Medicaid-eligible children.
Fourth, private insurance coverage of immunization services must be expanded to make employee health-insurance plans covering well-baby and well-child care available to the self-employed and to small businesses at group discount rates. Immunization coverage should be available without patient copayment, coinsurance or meeting annual deductible requirements. To offset the additional expense to insurance carriers, the government should allow a special 40-percent tax credit, with the balance of the extra cost deductible at 100 percent for all employees.
The good intentions that pave the road to children's health must be tempered with a shot of reality. To buy vaccines without ensuring the public knows how important they are and where, how and when to get them for their children is tantamount to answering a call for help by saying, "Call me in the morning."
C. Everett Koop was U.S. surgeon general from 1981 to 1989.
The Washington Post