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Tossing baby’s vaccine with the bath water
Vaccines for Children (VFC), designed to reduce under-vaccination problem in preschool children.
or the first time in de-
F cades, federal entitle
ments are facing real scr
utiny in Congress, .:5 frankly
it'sabouttime. Butintherushto
reign in social spending, there is
a risk that some good, cost-effec
tive federal programs could get
grouped in with the bad ones.
Once such example is the Vac
cines for Children (VFC) pro
gram, a federal entitlement de
signed to reduce America's
undervaccination problem in pre
school children.
In the last few months, some of
America’s least thoughtful com
mentators have attacked VFC,
declaring that it is wasteful and
unnecessary, that it exists only
because it evokes sympathy for
children, etc. But I have talked
to people who know a lot about
vaccination — pediatrics profes
sors, nurses, immunization re
searchers, public health experts
— and they all say the same
thing: that VFC is a cost-effec
tive prevention program, and
that it's accomplishing exactly
what it was intended to do.
The experts have the facts on
their side. Childhood immuni
zation is the most cost effective
health care intervention avail
able today, with estimated sav
ings of $lO in direct health care
costs and $25 in indirect costs for
every $1 spent. While lots of
federal programs claim savings
Augustan
graduates from
Naval Academy
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Navy Ensign Robert E.
Edwards, son of Patricia K. and
Robert E. Edwards Sr. of 189
Kestwick Drive, Martinez, re
cently graduated from the Unit
ed States Naval Academy in
Annapolis, Md., and was com
missioned at his present rank in
the United States Navy.
Edwards successfully complet
ed four years of intensive aca
demic, physical and professional
training, resulting in a bachelor
of science degree with a major in
political science. As a graduate
of the Naval Academy, Edwards
completed a four-year total-im
mersion program where a strong,
balanced academic program fo
cused on the educational needs
ofthe Navy, is superimposed over
a strict, professional military
training environment. The mili
tary training environment em
phasizes the development of lead
ership skills.
Edwards participated in a new
character development program
during his four years at the
school. The program discusses
issues such as ethics, honor, in
tegrity and human dignity.
In the summer, midshipmen
continue their preparation by
serving aboard ships and at shore
stations around the world.
Edwards was one of 895 men
and women who were commis
sioned as officers this year from
the academy.
Considered one of the top in
stitutionsin the country,the U.S.
Naval Academy was founded in
1845 and is celebrating its 150th
anniversary this year. The Na
val Academy has graduated more
than 60,000 men and women. Its
graduates have included 4,000
admirals and generals, one pres
ident, 200 members of Congress,
three governors, 73 Medal-of-
Honor winners, one Nobel Prize
winner and 40 astronauts.
The Naval Academy currently
has more than 4,000 midship
men, which comprise the Bri
gade of Midshipmen, and who
come from every state in the
union.
Ensign Edwardsisa 1991 grad
uate of Mira Mesa High School of
San Diego.
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like that, childhood immuniza
tion occupies the highest rungon
the ladder of cost-effectiveness.
There is no real doubt that, on
economic grounds, childhood
vaccination is a winner,
America has an under-vacci
nation problem. Our vaccina
tion rate for preschool children is
only about 65%. It was this low
rate that caused the 1989-91
measles epidemic in the US,,
during which 11,000 children
were hospitalized and 130 died.
Critics of VFC like to say that
the program is unnecessary be
cause America’s under-vaccina
tion problem was caused not by
the high cost of vaccine, but by a
failure to deliver vaccine to chil
dren who need it. That is a small
truth inside a big lie. Yes, for the
six traditional childhood vaccines
-measles, mumps, rubella, diph
theria, tetanus, and polio - cost
has not been a major obstacle to
vaccination, because govern
ment-subsidized vaccine has
been readily available. But here’s
the catch -the vaccines have
been available mainly in public
clinics. This has been very tough
on parents who take their chil
dren to a private doctor’s office
and who need public vaccine. It
means making a separate ap
pointment and a special triptoa
public clinic. Not only does it
fragment the child’s health care,
but many parents have chosen to
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simply skip the inconvenience of
the extra trip, leaving children
unvaccinated. Under VFC, chil
dren get their vaccines, because
VFC delivers public vaccine di
aectly to the doctor’s private of
ce.
Additionally, block granting
this program would result in an
unfunded mandate for states.
Currently the federal govern
ment keeps prices low because it
purchases vaccines for all states.
Repealing or block granting the
VFC program would require
states to pay higher costs to im
munize low-income children
which they will undoubtedly be
required to cover under state
Medicaid block grant proposals.
The Congressional Budget Of
fice says that VFC will gradually
rise in cost over the years. Un
doubtedly that is true. As new
high-tech vaccines become avail
able against diseases like herpes,
Lyme, and hepatitis, some will
be added to the childhood immu
nization schedule. The addition
of vaccines to the schedule is a
manifestation of medical
progress. If you favor progress,
you can't oppose the reasonable
addition, by experts, of new vac
cines to the schedule.
No, VFC should not be re
pealed. Through the CDC, the
federal government has main
tained a separate vaccine pro
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curement program for federal
and state health departments
since the 1960 s. Because of its
effectiveness andbipartisan sup
port in Congress, the program’s
authorization was kept separate
from health block grant programs
throughout all Democratic and
Republican Administrations.
Unfortunately, it has become
something it should never be - a
partisan issue. The real solution
is for Congress to work towards
enharicing VFC rather than dis
mantle a program that is clearly
vital to the goal of national im
munization. Evidence from the
states shows that physicians are
accepting VFC. And, according
to early studies, those fragment
ing referrals from private pedia
triciansto public vaccination clin
ics are declining.
On its present course, VFC will
not only help to solve America’s
undervaccination problem for
traditional vaccines, but it will
help finance the prevention of
other looming childhood diseas
es. Vaccines for herpes, Lyme
Disease, AIDS, hepatitis virus
es, and other illnesses are not too
far in the future. For those and
other emerging diseases, VFC
will insure that scientific
progress translates quickly into
real-world prevention. Repeal
ing or block granting this pro
gram will only be penny wise and
pound foolish.
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