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Immunization Initiative 6/13/91 [OA 8324]
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Immunization Initiative 6/13/91 [OA 8324]
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4
6
PROPOSAL: IMMUNIZATION EDUCATION AND ACTION COMMITTEE (IEAC)
HEALTHY MOTHERS, HEALTHY BABIES COALITION
Pesid #4
BACKGROUND
The current epidemic of measles in the United States has revealed
major flaws in the health care delivery systems, specifically
those systems which have failed to assure that children receive
vaccines appropriate for their ages according to the
recommendations of the Immunization Practices Advisory Committee
(ACIP) and the American Academy of Pediatrics (AAP).
The major victims of the measles epidemic are unvaccinated
preschool children, a large proportion of whom reside in the
inner cities of our Nation. While measles is the focus of the
current disease problem, there is the potential for the
resurgence of other vaccine preventable diseases. The measles
epidemic has served to expose deep rooted problems affecting the
delivery of all the childhood vaccines.
It is clear that a major effort is needed to educate parents and
guardians of the importance and effectiveness of today's
vaccines. It is also clear that increasing the demand for
vaccination services must coincide with the development of a
cadre of informed providers and more efficient and effective
vaccine delivery systems in both public and private sectors to
meet the increased demand.
An undertaking of this magnitude will require the cooperation and
coordination of a broad variety of agencies and organizations in
both the public and private sectors. Therefore, the Office of
the Surgeon General, U.S. Public Health Service, and the Division
of Immunization, Center for Prevention Services, Centers for
Disease Control have proposed, and are in the process of
developing an Immunization Education and Action Committee under
the auspices of the Healthy Mothers, Healthy Babies Coalition to
promote the vaccination of preschool age children. We are
enlisting the participation of:
o Provider Organizations: To assure that physicians and
nurses are fully implementing current recommendations to
take advantage of all opportunities to vaccinate and to
reduce barriers to immunization.
O Parents/Guardians Groups: To inform them of the importance
and effectiveness of the timely vaccination of their
children.
0 Volunteer Groups: To educate and motivate parents and
guardians; to educate community leaders of the needs and
benefits of immunization, which will have the effect of
building grassroote support for higher priorities
forimmunization services and resources. Critical to include
among these groups are those who are known to work
effectively to serve the needs of minorities.
O Health Care Delivery Agencies and Organizations: To assure
that policies, procedures, and operations, in both public
and private sectors, are optimal for the delivery of
immunization services.
DRAFT MISSION STATEMENT: The mission of the Immunization
Education and Action Committee (IEAC) is to use
information/education methods to significantly enhance
achievement of the goal of 90% percent immunization coverage of
U.S. children by 2 years of age by:
1. Increasing the awareness of parents and guardians of the
importance, efficacy, and safety of childhoood immunizations as
an essential component of comprehensive child health care;
2. Developing informed advocates, organizations, and community
leaders to promote use of immunization services;
3. Promoting the optimal use of resources by fostering
collaboration among public and private health care providers and
the community.
Draft Major Goals: The major goals of the IEAC are to:
0 Strengthen collaboration among all groups working with
immunization.
o Develop national and local advocacy for immunization.
o Develop strategies for maximizing consumer demand for
immunization.
0 Develop and distribute effective immunization information
and education materials.
0 Develop strategies which enhance vaccine delivery by
health care providers.
0 Evaluate the effectiveness of the methods used to achieve
the goals and objectives of the IEAC.
Organizations Invited to HMHB Meeting
American Academy of Family Physicians *
American Academy of Pediatrics *
American Medical Association *
American Nurses Association *
Asian American Health Forum
Association of Junior Leagues International
*
Association of State and Territorial Health Officials *
Children's Defense Fund *
Connaught Laboratories
Delta Sigma Theta Sorority
Health Resources and Services Administration
Kiwanis International *
Lederle-Praxis Biologicals
March of Dimes Birth Defects Foundation *
Merck Sharp and Dohme
National Institutions Association of Children's Hospitals and Related *
National Association of Community Health Centers *
National Association of County Health Officers *
National Practitioners Association of Pediatric Nurse Associates and *
National Organizations Coalition of Hispanic Health and Human Services
National Council of La Raza
National Hispanic Education and Communications Projects
National Medical Association *
National Parent-Teachers Association
*
National Urban League
Rotary International
Sclavo Incorporated
Smith Kline Beecham
The Children's Action Network
U.S. Conference of Local Health Officers
*
Voluntary Hospitals of America
Wyeth Ayerst Laboratories
Those organizations underlined and in bold attended the meeting.
Denotes Coalition. membership in the Healthy Mothers, Healthy Babies
SERVICES
HUMAN
DEPARTMENT OF HEALTH & HUMAN SERVICES
Public Health Service
HEALTH
of
DIPARTMENT
Memorandum
Date
MAY 29 1991
9i 31 PM 2: 10
HHS-OASPA
From
Assistant Secretary for Health
Subject
"The Healthy Difference Program," Secretary's Program Direction #4
To
Assistant Secretary for Management and Budget
Assistant Secretary for Planning and Evaluation
Assistant Secretary for Public Affairs
PHS Agency Heads
OASH Staff Office Directors
Attached for your information are the materials sent to some 30,000 HHS
grantees and district offices as part of "The Healthy Difference Program," a
Secretarial initiative designed to use these channels for health promotion
targeted to the people served by the Department. This mailing addressed
immunization, and four additional mailings over the next six months will
address alcohol, smoking, diet, and physical activity. The initiative was
launched in an extremely short time thanks to the full cooperation of many of
your offices. The Secretary and I both wish to convey our appreciation to you
and your staffs for their contributions to this effort.
James 0. maron James O. Mason, O. mason M.D.,
Dr.P.H.
Attachments
THE WHITE HOUSE
WASHINGTON
June 11, 1991
MEMORANDUM FOR THE PRESIDENT
THROUGH:
TONY SNOW TS
FROM:
MARK LANGE mL
SUBJECT:
IMMUNIZATION INITIATIVE
On Thursday, June 13, at 9:15 a.m. in the Rose Garden, you
will announce an initiative by Secretary Sullivan to increase
immunization for preschoolers.
The audience of 200 will include federal and state health
officials and some recently immunized children. The remarks are
5 minutes on cards.
(Lange/Simon)
June 11, 1991
6:30 P.M.
[SHOT. TS2]
PRESIDENTIAL REMARKS:
CHILDHOOD IMMUNIZATION INITIATIVE
THE ROSE GARDEN
THURSDAY, JUNE 13, 1991
9:15 A.M.
[[ Secretary Sullivan, Assistant Secretary James Mason, Surgeon
General Novello, Centers for Disease Control Director Bill Roper;
state and local health officials, experts from the Centers for
Disease Control, industry leaders
and especially for you kids
here in the audience:
I'll try to be brief. Honest -- this'll only hurt a little.
]]
You know, when we announced our National Education Goals,
the very first was that "By the year 2000, all children in
America will start school ready to learn."
That's one reason we put such emphasis on our Healthy Start
initiative. Every child deserves a chance -- and in the 1990's
no child in America should be at risk to deadly diseases like
diphtheria, polio, and measles.
A decade ago we hoped to eradicate these threats -- and
thanks to those of you here today, and many others, we made
remarkable progress.
On behalf of a grateful nation, let me thank you for all
you've done -- and urge you to get on with the job at hand.
2
Because despite our successes, 1990 brought the largest number of
measles cases since 1977 -- a 50 percent increase over 1989.
That's why I commend Secretary Sullivan, Surgeon General
Novello, CDC Director Roper and others, for forming their HHS
"SWAT Team" to visit six major cities, and work with state and
local health officials. They want to help get kids immunized --
and, they want to get every community mobilized.
We need to find out what works -- and make sure the word
spreads, so the disease doesn't. By getting to kids sooner -- by
educating parents and finding creative ways to get them into
clinics -- we can see that no child is left vulnerable without a
vaccine.
My budget for 1992 calls for an additional $40 million for
the CDC immunization program. Overall, federal funding for
immunizations has more than doubled since 1988.
But a problem like this one won't be solved by simple
directives from Washington. You must assault it from all angles
and levels -- with public health efforts, with creative
partnerships between the non-profits and the private sector, with
conscientious action on the part of parents, teachers, and
citizens.
We have plenty of vaccines. But we must do the hard work of
logistics, planning and coordination to get the medicine to kids
who need it -- especially in urban neighborhoods.
Let me thank all of you here today -- and especially applaud
the efforts of the Junior Leagues, the Children's Action Network,
3
and the many other organizations and individuals who have been
committed to childhood immunization programs for years. Your
remarkable work to build awareness will get results, I'm certain.
Throughout our health policy programs, we're putting new
emphasis on prevention. America is a humane and caring society,
that cannot condone unnecessary suffering. What's more, to
remain a vital society, we cannot afford to waste human
resources. Disease prevention represents our best opportunity to
reduce the ever-increasing portion of our resources that we now
spend to treat preventable illness.
For the sake of children who need protection from childhood
diseases, we're trying creative ideas like "one-stop shopping"
for health care, and escorted referral for "express lane"
immunization at nearby clinics. By encouraging all health care
professionals never to miss a chance to give a shot we'll have a
fighting chance to get ahead of these diseases.
Along with all who serve in health care, today I call on
every parent in America: don't take a chance. Make sure your
child is immunized. 11
A deadly plague called polio threatened my generation --
darkened the fun of summers, crippled and killed kids.
But American ingenuity stopped that killer. And while some
say each generation repeats the mistakes of the last, no
generation in America should suffer the plagues of the past.
4
American decency demands that we not let complacency lead to
contagion -- and never let apathy lead to epidemic. With the
efforts of people like you, we can turn this tide forever.
God bless you all.
# # #
(Lange/Simon)
June 7, 1991
11:30 P.M.
[SHOT.TS]
PRESIDENTIAL REMARKS:
CHILDHOOD IMMUNIZATION INITIATIVE
THE ROSE GARDEN
THURSDAY, JUNE 13, 1991
[ TIME ] 9:15 a.m.
James
[[ Secretary Sullivan, Assistant Secretary Mason, Surgeon
CDC Director
^
General Novello, ^ Bill Roper; state and local health officials,
experts from the CDC.
...and especially for you kids here in the audience: I'll
try to be brief -- because a long speech is about as much fun as
a long needle. 11
Honest -- this'll only hurt a little. 11 ]]
State of the
You know, when we announced our National Education Goals,
Union
the very first was that "By the year 2000, all children in
1-29-90
America will start school ready to learn."
That's one reason we put such emphasis on our Healthy Start
initiative. Every child deserves a chance -- and in the 1990's
no child in America should be at risk to deadly diseases like
diphtheria, polio, and measles.
These threats -- which seemed on the verge of eradication a
see
Roper
testimony
decade ago -- have enjoyed a cruel and recent resurgence. 1990
4
brought the largest number of measles cases since 1977 -- and the
UPI
a
increase over
number of cases has jumped 50 percent since 1989.
That's why Secretary Sullivan, Surgeon General Novello, CDC
Director Roper and others have formed an HHS "SWAT Team" -- or
maybe it's "Shot Team" -- to visit six major cities. They want
2
to know why kids aren't getting immunized. And they want to get
every community mobilized.
We need to find out what works -- and make sure the word
spreads, so the disease doesn't. By getting to kids sooner -- by
educating parents and finding creative ways to get them into
clinics -- we can see that no child is left vulnerable without a
vaccine.
WH
My budget for 1992 calls for an additional $40 million for
fact sheet
the CDC immunization program. Overall, federal funding for
5-13-91
immunizations has more than doubled since 1988.
But a problem won't be solved by simple directives from
Washington. You must assault it from all angles and levels --
with public health efforts, with creative partnerships between
the non-profits and the private sector, with conscientious action
and
on the parts of parents, teachers, citizens.
We have plenty of vaccine. But you have to do the hard work
of logistics, planning and coordination if you want to get the
medicine into kids who need it -- especially in urban
neighborhoods. We've celebrated that kind of effort in Desert
Storm -- now let's put it to work to stop disease. 11
Debbie
Let me thank all of you here today -- and especially applaud
Messick
the efforts of the Junior Leagues, and the Children's Action
HHS
Your
245-
Network. will You re doing remarkable work to build awareness Mand and
1850
to get results. I'm Sure,
Now let's put new emphasis on prevention -- and try creative
PHS
ideas like "one-stop shopping" for health care, and escorted
release
3
referral for "express lane" immunization at nearby clinics. By
encouraging all health care professionals never to miss a chance
to give a shot -- we'll have a fighting chance to get ahead of
these diseases.
You know, a deadly plague called polio threatened my
generation -- darkened the fun of summers, crippled and killed
kids needlessly
But American ingenuity stopped that killer. And while every
generation may repeat the mistakes of the last, no generation in
America should suffer the plagues of the past.
American decency demands that we not let complacency lead to
contagion -- and never let apathy lead to epidemic. With the
efforts of people like you, we can turn this tide forever.
God bless you all.
# # #
alcohol, including 450,
verage of 15 drinks each week, accor
Tue survey of teenage alcohol use that Surgeon
ello called "shocking. If
The survey by the HHS Department's inspector general's office
found that an estimated 6.9 million teenagers, including some as
young as 13, have no problem obtaining alcohol with false
identification or from liquor stores that do not check ages. In
addition, about one-third of the nationwide sample of 959 students
reported having accepted rides from persons who had been
drinking
Novello said she was "flabbergasted" by some of the
findings, adding that they emphasize the need for parents to play
a greater role in educating youngsters about dangers of alcohol.
(Michael Isikoff, Washington Post, A1)
6-7-91
MEASLES CASES INCREASE BY MORE THAN 50 PERCENT
ATLANTA -- Measles, which health officials had hoped to
eradicate in the U.S. nearly a decade ago, struck 27,672 Americans
and killed 89 in 1990, it was reported. The total was a 52.1
percent increase from 1989 and the most cases since 1977 the
federal CDC reported Thursday. The 1991 figures, however, could
indicate that health officials may have gotten a handle on slowing
the disease. Through June 1, there were 5,691 cases reported to
the CDC, compared to 10,378 for the same period last year.
(Charles Taylor, UPI)
EDITOR'S NOTE: "AIDS Definition Excludes Women, Congress Is Told, "
by Philip Hilts, appears in The New York Times, page A19.
hold up the reconfirmation of
chief banking regulator until the inquiry
Riegle, who has been seeking information on
months, told Comptroller General Bowsher he wants to know
story" of who the borrowers were and why bank examiners from
Office of the Comptroller of the Currency failed to discover th
$20 billion bank's problem sooner. Riegle said examiners have
found "several cases" of preferential loans to directors, officers,
stockholders and others with connections to the bank.
(Susan Schmidt & Jerry Knight, Washington Post, G1)
HILL FIGHT STARTS OVER GOVERNMENT SECURITIES RULES
A fight is shaping up in Congress over whether the Treasury
Department or the SEC should regulate the government securities
market
Thursday, Treasury officials sent legislation to
Congress proposing that the department be primarily responsible for
setting rules
But the House committee in charge of securities
regulation is planning to release its own draft of proposed
legislation that would make the SEC the primary rulemaker. The
draft could be made public as early as next week, congressional
sources said.
(Kathleen Day, Washington Post, G2)
EDITOR'S NOTES: "Personalities," by Chuck Conconi, appears in The
Washington Post, page C3.
"Gephardt-Rostenkowski Relationship Explains Some Democratic
Failures," by Jackie Calmes, appears in The Wall Street Journal,
page A14.
###
/
FACSIMILE
PLEASE NOTIFY OR HAND-CARRY
THIS TRANSMISSION TO THE
FOLLOWING PERSON AS SOON AS
POSSIBLE:
Name:
MARK L LANGE
Address:
Telephone:
Number of pages being transmitted (including this one)
FROM:
FAX number: 245-2247
Office Number:
PO1
06. 11. 91 05:05PM *DHHS/IOS 245-7591
Two months ago I announced the greatest Education Initiative
our country has seen. The highest priority was given to ensuring
that, "by the year 2000, all children in America will start school
ready to learn." That's one reason that we put such emphasis on
our Healthy Start initiative. Every child deserves a chance -- and
in the 1990's no child in America should be at risk to deadly
diseases like diphtheria, polio, or measles.
One of the fundamental tenets of effective, quality education
is preparing our students to enter school as healthy human beings
-- people who can focus on learning the state capitols instead of
being preoccupied with sickness and disease.
As part of our strategy to send healthy children into the
classroom, Secretary Sullivan, Surgeon General Novello, and CDC
Director Roper - along with others -- have formed an HHS "SWAT
Team" to visit six major cities. Their mission is to examine the
reasons why many of our nation's children lack proper immunization.
This team will focus attention on new ways to expand the
immunization programs -- to make sure the word spreads, and the
disease doesn't. By getting to kids at an earlier age -- by
educating parents and finding effective ways to get them into
clinics -- we can see that no child is left vulnerable to
preventable childhood disease.
PO2
16S2-962 - SOI/SHHG* 09:90:90 IS II '90
My budget for 1992 calls for an additional $40 million for
CDC immunization programs. This funding is targetted to efforts
to improve and expand immunization services, particularly in
communities where current programs are deficient. Such federal
funding for immunization has more than doubled since 1988.
But this problem can't be solved by simple directives from
Washington. We must assault it from all angles and levels --
incorporating public health efforts, encouraging creative
partnerships between non-profit organizations and the private
sector, with parents and teachers.
Ten years ago we thought this country had conquered measeles.
Now, we've realized that more than technology is necessary to win
this battle. We must mobilize the nation to make our children our
highest priority.
Let's put new emphasis on prevention. We can't be hesitant
to try creative ideas like "one-stop shopping" for health care, or
escorted referral for "express lane" immunization at local clinics.
We need to encourage every health care professional to make sure
that each child has receive proper innoculation.
Our nation has in its stockpile vaccines to combate the,
illnesses that threaten to rob our children of their health. The
science -- the technology -- is there to prevent these childhood
maladies.
POS
16S4-97Z SOI/SHHG* Na90:90 16 "II '90
Now your challenge is to bring these vaccines to the children
of this nation. In Desert Storm we proved that American skill and
effective planning can lead us to victory. Now we need to focus
that same determination on the health of this country's youth. We
must ensure that our children have the healthiest, happiest
childhood we can give them.
God bless you all.
####
P04
16S2-SPZ SOT/SHHO* WI90:90 I6'II'90
Hunnes Huttner
Immunization Points
Context:
-
National Education Goals. Goal #1: "By the year
2000, all children in America will start school ready
to learn." Objective 3 under this goal: "Children
will receive the nutrition and health care needed to
arrive at school with healthy minds and bodies
=
With the immunization initiative, the President is
moving us towards fulfilling this goal.
-
Prevention Strategy. Our argument in the health
debate is that we want to focus on outcomes -- a
healthier America while the other guys are off on the
same redistributionist, resource consumption
inequities argument they usually pursue.
We also want to invest in the future, buying health
care that is cost-effective. Immunization is highly
cost effective.
In his visit to Chicago on May 13, the Vice-President
announced the Administration's commitment to
porus
improving the health of our nation's children through
missed
supporting immunization. He visited one of CDC's
pilot immunization projects that is testing the
effectiveness of "one-stop shopping" for the children
of low-income families who need immunizations (CDC
has two other similar pilot projects, in New York and
Jersey City). The President had been scheduled to
make this visit, but asked the Vice President to go
in his stead, during the President's recent illness.
The President has requested an additional $40 million
in FY 1992 for the Centers for Disease Control's
immunization program, for a total of $258 million --
an increase of 19 percent over 1991. Of this
increase, $35 million will be targeted to increasing
immunizations of preschool children in low-income
minority populations. Overall, federal funding for
immunizations has more than doubled since 1988.
-
Help those who need it most
George Bush does not reject the power of government
to do good. We're disappointed that those who have
been failed by the operation of the vaccine delivery
system have been those who need it most -- poor,
minority kids. We want to make sure they have the
same opportunity to live healthy childhoods as better
off children.
Points we want to get across
-
As a "problem" low immunization rates are a local
problem, primarily in areas of the concentrated poor
or new immigrants in inner city.
-
If there ever was a domestic issue to which Desert
Storm is an appropriate analogy, this is it. Getting
kids immunized is a logistics issue -- we have the
resources in place to buy all the vaccine we need to
buy. The challenge is getting it into the arms of
kids.
-
There's some room for bureaucracy bashing. In part
the arrogance of the public health system, providing
immunization when and where the public health
administrators want it, is at the root of the
problem.
-
a call for new thinking/new approaches/new
methods
-
We have low immunization rates in the same
neighborhoods in which fast food establishments
flourish. Moral: Our public health system
needs to be mindful of the customer, as mindful
as McDonald's.
SENT BY:The White House
; 6- 5-91 11:34AM ;
CABINET AFFAIRS-
2024566218;# 2
05. 30. 91
11:54 AM
P02
SERVICES.
DEPARTMENT OF HEALTH 4 HUMAN SERVICES
Office of the Secretary
(
Washington, D.C. 20201
MEMORANDUM FOR DANIEL CASS
FROM:
DEBBIE MESSICK
01
SUBJECT:
IMMUNIZATION TALKING POINTS FOR POTUS SPEECH
JUNE 13, 1991
THE ROSE GARDEN
CC:
ALIXE GLEN
Attached are talking points that might be helpful as the
speechwriters begin their task for the June 13 Rose Garden event
focusing on Immunisation.
The President will be announcing a significant new Immunisation
Initiative that has been in the planning stages at the Centers
for Disease Control for several months. Details of this program
are the focus of point 5 on the Talking Points. This plan is in
response to a national epidemic addressed by the National Vaccine
Advisory Committee in its report on Jan. 8, 1991.
In addition, our recommendation is that Secretary Sullivan will
recognize the following HHS officials for their efforts on this
important issue: Dr. Jim Mason, Assistant Secretary for Health;
Dr. Antonia Novello, U.S. Surgeon General; and, Dr. Bill Roper,
Director of the Centers for Disease Control. The Secretary will
then introduce the POTUS.
Let me know when its convenient for us to meet with you and the
speachwriter to discuss details.
Thank you.
SENT BY:The White House
; 6- 5-91 :11:34AM ;
CABINET AFFAIRS-
2024566218:# 3
05. 30. 91
11:54 AM
PO3
1.
CHILDHOOD INDUNITATION NAS SERM VERY SUCCESSFUL IN
CONTROLLING VACCINE PREVENTABLE DISEASES IN THE UNITED
STATES:
.
Reductions of at least 904 from peak levels have been
achieved for diphtheris, measles, mumps, pertussis,
polio, and other diseases preventable by vaccination,
D
Immunisation levels are 97-984 at the time of school
entry for all diseases preventable by vaccine.
2.
DESPITE THESE ACHIEVEMENTS, TOO MANY CHILDREN ARE STILL
SUFFERING AND DYING FROM DISEASES THAT ARE EASILY
PREVENTABLE BY VACCINATION:
o
In the last two years, 45,000 cases of measles and over
100 deaths securred, the largest number of deaths from
measles in over two decades,
o
The majority of cases and deaths have occursed among
Laner city, minerity children/ immunisation coverage
among Laner city children has been neted to be as Low
as 300 in some cities.
3. THE PRINCIPAL CAUSE or THE NEASLES EPIDEMIC IS FAILURE TO
VACCIMATE AT THE RECOMMENDED AGES, NOT FAILURE or THE
VACCINE.
4.
as SERIOUS AS THE MEASLES SPIDEMIC MAY DE, THE CAUSES or THE
EPIDEMIC LEAD TO EVEN GREATER CONCERN ABOUT THE MATION'S
CURRENT SYSTEM AND CAPACITY FOR DELIVERING VACCINES TO
CHILDREN.
Si BY The White House
; 6- 5-91 :11:35AM ;
CABINET AFFAIRS-
2024566218:# 4
0.5. 30. 91
11:54
AM
P 0 4
5. Today, it is with great pleasure that I "unveil"
a
significant new Administration program to solve this problem.
Implemented at the Department of Health and Human Service's
Centers for Disease Control, the Initiative includes the
following action items:
o
Formation of a national childhood immunization
coalition (FYI, the audience will include members of the
coalition, sea attached "sample" list.) The problem is bigger
than simply getting vaccine into the arms of our youngsters. It
is going to take a public/private partnership of great magnitude
to overcome the barriers to preventable disease our children
face. Each of you here today have an important role to play in
addressing this national crisis.
0
State Plans: Much of the work must be done at the
state and local level, where the services actually are delivered.
Because of the seriousness of the situation, I have asked
Secretary Sullivan and the other distinguished HHS officials with
& special expertise in this subject (i.e., Mason, Novella, Roper)
to travel with teams of immunization experts into targeted local
communities. our nation's foremost health experts will work with
state and local officials in refining and finalizing their state
plan to raise immunization levels among preschoolers. our goal
is to inoculate 90% of preschool age children.
o
Standards of Immunization: H have asked HHS, in
coordination with the medical providers, to develop standards of
immunization practice for our nation. These standards should
assure that immunisation is available on request at convenient
times and that children are not required to have comprehensive
physical evaluations when they are not readily available.
Attachments:
Immunization Budget Summary
POTUS Talking Points
Measles White Paper
Immunization Coalition List
Background Charts
The Children's Action Network
cy & Bob Daly
Capshaw & Steven Spielberg
Je & Mark Johnson
Diana Meehan & Gary Goldberg
91MMY-6 F.: 2:54
Lorraine & Sid Sheinberg
Stacey & Henry Winkler
April 26, 1991
Debbie Messick
Deputy Assistant Director for
Public Affairs
200 Independence Avenue, SW
Room 647D
Washington, DC 20201
Dear Debbie,
I enjoyed speaking with you the other day regarding the Children's Action
Network immunization project. I've attached a brief outline of the Network
and our immunization campaign.
I look forward to our working together on this important issue. Please don't
hesitate to call me at (213) 399-7444 if you have any questions.
Sincerely,
Jennifer Perry
Executive Director
Attachment
Jennifer Perry
Executive Director
1930 14th Street
ta Monica, CA 90404
B) 399-7444
GIVING OUR KIDS THEIR BEST SHOT
Mobilizing the Nation to Immunize America's Children
SPONSORED BY:
CHILDREN'S ACTION NETWORK
and
AMERICAN ACADEMY OF PEDIATRICS
A Project of the Tides Foundation
Why a National Immunization Campaign?
Although the U.S. nearly eradicated measles in the early 1980s, today measles epidemics
are breaking out once again in cities across the country. At the same time, outbreaks of
rubella, or German measles, whooping cough, and polio are also rising dramatically. As
fewer children are getting immunized, more and more children are getting sick and dying
from diseases that are preventable.
60%
Measles Outbreak. Measles surged from an all-time low of 1,500 cases in 1983 to
nearly 45,000 cases in the last two years Health officials project that the number of
children who will die from measles this year will be the highest in 25 years.
Immunization Rate. Nationally, 3 out of every 10 American 2-year-olds fail to get
the proper immunizations. In the inner cities, as many as 50% of two year olds are not
fully immunized. Today, children are more likely to be vaccinated in some Latin
American and Third World countries than here in the United States.
Health Care Costs. Every dollar spent on immunization saves $10 in later health care
costs. Thus the staggering cost to the nation's health care system of not immunizing
children is greater than the cost of a workable immunization strategy that safeguards our
children.
It is essential that we reach out to the families who are not receiving immunizations
because they are not aware of the importance of basic health care or the services
available to them. It is also important that we improve coordination of services since too
often systemic barriers make it difficult for families to get their children immunized.
America cannot expect to compete and prosper if our children are dying of preventable
diseases and if millions more are left to live with untreated health problems.
The National Immunization Campaign
In the face of a growing children's health care crisis, the entertainment industry, through
the Children's Action Network (CAN) and the American Academy of Pediatrics (AAP)
have joined together to launch a national effort to immunize children and focus the
nation's attention on improving health care for our young. CAN and AAP are working
closely with the Centers for Disease Control, the U.S. Surgeon General and other medical
profes sionals, community organizations, public health officials, and social service
agencies to make sure that the National Immunization Campaign supports ongoing
efforts to improve immunization services.
The National Immunization Campaign will be a sustained high-profile media and public
awareness campaign, combined with a grassroots organizational effort, to educate the
public about immunization and to help establish an organizational infrastructure which
can address the nation's long-term immunization needs. In addition, the Campaign will
coordinate with health care providers to immunize children in a select number of high-
risk cities across the country. The Campaign activity will be most visible during
National Immunization Week, September 23 - 29.
The Goal. To ensure that every American child is fully vaccinated by the age of 2,
and remains up to date on their immunizations.
The Objectives. The National Immunization Campaign has several short term and
long term objectives.
*
To raise public awareness and increase support for immunizations
*
To reach out to families in need of immunization services with information and
specific opportunities to get their children immunized
*
To develop and support increased collaboration of service providers and health
professionals involved in education and immunization services
To develop and distribute vaccination schedules, materials on vaccination and
children's health care to a network of health care providers and children's service
organizations
*
To promote ongoing health care delivery to children by putting them in touch
with a regular source of care
To establish a mechanism to support implementation of long term strategies to
provide immunizations to all children
To promote policies that will provide adequate funding to immunize all children
The Outreach. The Campaign will focus on several target groups.
Families in high-risk cities. A targeted education campaign will be aimed
specifically at those families in high-risk cities who have not immunized their
children. This effort is designed to provide at-risk families with the information
and support they need to get their children vaccinated.
The general public and opinion leaders. A national public awareness campaign
aimed at the general public will provide all parents the opportunity to get the
information they need to assess and fulfill their children's immunization needs. In
addition, the national campaign will target opinion leaders in an effort to help
build a national mandate to affect public policy.
Health and social service community. An organizational campaign will build a
coalition of health and social service providers who can more effectively work
together to foster immunization efforts and who can distribute information to help
reduce the barriers to immunization.
The Campaign.
At the national level, broad public awareness activities will include:
print, radio and TV Public Service Announcements (PSA's)
use of 800 number on PSA's and print materials to disseminate information
about immunizations to families
a July kick off event with celebrities and medical experts
movie trailers to be used by theaters in the late summer and early fall
inclusion of immunization stories in TV programming
interviews by celebrities and medical experts
articles and news features in national and minority media.
The national effort will make sure that the general public, regardless of socioeconomic
status, will have access to immunization information.
Simultaneously, the Campaign is working with professional associations and service
providers nationwide to build collaboration in immunization services delivery and to
support policies that will provide adequate funding for vaccines and access to health care
for all children. A national task force on immunization and children's health will be
established to formulate and implement these goals.
At the local level, the Campaign is building coalitions of social and health service
providers, children's advocacy organizations and community organizations to conduct
immunization-related activities while dealing with the long term immunization needs
within the community. Coalitions are being built in the following cities:
Chicago, Illinois
Detroit, Michigan
Houston, Texas
Los Angeles, California
Miami, Florida
New York, New York
Philadelphia, Pennsylvania
Washington, DC
During National Immunization Week, events in target communities will include on-the-
ground immunization activities in a fun-oriented environment with incentives to attract
target families. With the help of health care professionals, these events will provide
children with screening, immunization assessments, actual immunizations and
information for follow-up immunizations. These events are intended as a focal point to
allow local organizations to develop longer-term immunization efforts as well as to
provide a visible media event to encourage families to participate.
National Immunization Week will be a time for children and families. In each of the
target communities:
* Media events with celebrities, health professionals and families will draw
attention to local efforts to improve immunization services while mobilizing
families to participate in National Immunization Week activities.
Children will receive basic childhood immunizations.
*
Families will receive immunization information, including schedules,
reminders, referrals etc.
Entertainment and incentive programs at every site will make this a day that is
fun for families and provides them with much needed health services. Sites will
be visited by celebrities from television, film, radio, sports, and news.
In some cities, depending on local resources, there will be exhibitions and
activities that promote health education. Dental, vision and hearing screenings
may also be available.
The Future. The National Immunization Campaign will work to promote ongoing
health care delivery to children by connecting them with a regular source of care and by
creating a policy environment where adequate funding for the immunization of all
American children is a priority.
Who is the Children's Action Network?
The Children's Action Network is an organization composed of entertainment industry
leaders dedicated to raising the profile of children's issues through the media. The
Network's founding families include; Nancy and Bob Daly, Diana Meehan and Gary
Goldberg, Lezlie and Mark Johnson, Lorraine and Sid Sheinberg, Kate Capshaw and
Steven Spielberg and Stacey and Henry Winkler.
The Network's goal is to inform the public about the needs of children and encourage
parents, families, civic, community, business and political leaders to do their part for
children. The Network is marshalling the resources of the entertainment industry
towards improving the health of children.
Who is the American Academy of Pediatrics?
The American Academy of Pediatrics is an organization of 41,000 pediatricians
dedicated to improving the health, safety and well-being of infants, children, adolescents
and young adults. Antoinette Eaton, M.D. is the 1990-1991 AAP President. James
Strain, M.D. is the AAP Executive Director.
THE CHILDREN'S ACTION
NETWORK
A MEDIA VOICE FOR KIDS
THE CHILDREN'S ACTION NETWORK
A MEDIA VOICE FOR KIDS
Nancy and Bob Daly
Diana Meehan and Gary Goldberg
Lezlie and Mark Johnson
Lorraine and Sid Sheinberg
Kate Capshaw and Steven Spielberg
Stacey and Henry Winkler
Jennifer Perry, Executive Director
1930 14th Street
Santa Monica, CA 90404
(213) 399-7444
AMERICA'S CHILDREN ARE IN CRISIS
1 in 5 children lives below the poverty level
One-half million children drop out of school each year
The United States ranks behind 19 other nations in infant mortality
More than 500,000 children are homeless
1 in every 5 American girls bears a child before the age of 20
More than 12 million children have no health insurance
AMERICA'S CHILDREN NEED OUR VOICE
The Children's Action Network is comprised of members of the entertainment
industry committed to using the power of the media to make children a top priority
in American life.
The Network works with children's advocacy and service organizations nationwide to
promote specific policies and programs that benefit children.
The Network's goal is to inform the public about the needs of children and encourage
parents, families, civic, community, business and political leaders to do their part for
children.
The Children's Action Network Statement of Purpose:
1. To serve as a "call to action" to the entertainment industry, inspiring the
inclusion of children's issues in the industry's creative products.
The entertainment industry plays a key role in shaping popular culture and
can have a major impact on how America views our nation's children. The
Children's Action Network will reach out to members of the entertainment
community through briefings, symposia and conferences in order to inform
them of the major issues affecting today's children and encourage them to
integrate children's issues in their work.
2. To serve the entertainment industry as a resource on children's issues.
The Children's Action Network will serve as a central clearinghouse on
children's issues for the creative community. The Network will provide top
quality information and expertise for writers, producers and directors as
well as assistance in locating people and materials.
3. To produce special events and programs that publicize and promote
children and their needs.
The Network will produce special events and programs that raise the
visibility of children's issues and, when appropriate, provide direct
solutions to problems affecting children.
4. To enlist the industry's creative and production resources to produce
materials that benefit children.
The Network will work with the entertainment industry to organize a pool
of creative and production resources, in order to help support efforts on
behalf of children.
5. To build strong leadership for children in the entertainment industry,
and encourage industry leaders to speak out for children.
As parents and professionals, members of the entertainment industry have
a unique ability to reach out to the public. Network members will be
encouraged to speak out for children in the legislature, the Congress, the
media, and at special events.
6. To create a bridge between the entertainment community and
organizations working directly with or on behalf of children.
The Network will act as a liaison between individuals in the entertainment
industry and children's service organizations, encouraging individuals to
take an active role in an organization and learn from the day-to-day
experiences of children and those who work with them.
PILOT IMMUNIZATION PROJECTS
The high immunization coverage at school-entry indicates that
parents do not oppose immunizations, but merely that, in the case
of poor, inner-city populations, they need to be reached earlier,
SO that immunization is a priority long before it is required for
school. We believe that reaching people when they are
interacting with government in other ways may be an answer.
Thus, we have just begun demonstration projects at eight sites
Chicago and six sites in New York City -- using the "one stop
shopping" concept. In these projects, when clients of the
Department of Agriculture's Women Infants and Children (WIC)
program come to pick up their vouchers or otherwise interact with
the offices, an assessment of their children's vaccination status
is made and they are being given the opportunity to get their
children immunized right then and there or are escorted to nearby
clinics where they get "express lane" treatment for the
immunizations needed -- whether it is measles, DPT, polio or Hib
vaccines that are needed. In Jersey City, we have a similar
project involving our own Aid to Families with Dependent Children
clients. Progress reports from these projects should be
available later this year.
In these pilot projects, we're not barring people from
either food or welfare in any of these pilot programs, even if
they refuse immunization. I would oppose that. We are, as I
said, helping children, not punishing them.
#
#
#
#
Provided by: PHS News Division, Bill Grigg, 245-16867
the Leaguar, Childrens that
June 5, 1991
MEMORANDUM FOR MARK LANGE
FROM:
BOB SIMON Rd
SUBJECT:
IMMUNIZATION
Key Announcement:
(shot)
An HHS SWAT team consisting of Sec. Sullivan, Asst. Sec. of Health
James Mason, Surgeon Gen. Antonia Novello, and CDC Dir. Bill Roper
will visit six major cities to find out why preschool children
aren't getting immunized and what can be done to change that. They
will then tell other cities "what works."
Problem: 2- and 3-year olds aren't getting immunized, mainly
minorities in the inner cities. As a result, measle cases have
skyrocketed. Government at all levels and the private and non-
profit sector must act together to reverse this trend. And it is
reversible! It's been done before.
(we fund it.
,Hey do it
In the audience: state and local health officials, drug makers,
CDC officials, DC kids who have recently been immunized.
Stress both parental responsibility ("culture of character") and
professional responsibility (doctors and nurses) to never miss an
opportunity to give shots.
Note that Junior League and Children's Action Network will soon
launch public awareness campaigns to highlight this cause.
Note that all 50 states require immunization for admittance to
school, so that by age 5, 97% of all kids are immunized. The goal
here is to get kids immunized sooner, so that preschoolers stop
getting these preventable diseases.
"Give kids our best shot"
"Don't wait to vaccinate"
we want to ident. what wahn
part of Healthy Start, part of educ goal
HEALTHY
Dr. Sullivan says
PEOPLE
You CAN Make a Difference!
2000
The Healthy Difference
Program Guide
SERVICES
HUMAN
USA
HEALTH
Messages for better health from the
OF
U.S. Department of Health and Human Services
DEPARTMENT
to all those it serves.
U.S. Department of Health and Human Services
These agencies are participants in the Healthy
For more information about the program, write to :
Difference program:
ADMINISTRATION FOR CHILDREN
Administration for Children and Families
AND FAMILIES
Office of Communications
Public Affairs Division
Aerospace Building
6th Floor
901 D Street SW.
Washington, DC 20447
ADMINISTRATION ON AGING
Administration on Aging
Technical Information and Dissemination
Division
Wilbur J. Cohen Building
Room 4646
330 Independence Avenue SW.
Washington, DC 20201
HEALTH CARE FINANCING
Health Care Financing Administration
ADMINISTRATION
Office of Public Affairs
Hubert H. Humphrey Building
Room 435H
200 Independence Avenue SW.
Washington, DC 20201
PUBLIC HEALTH SERVICE
Public Health Service
Office of Health Communications
Communication and Service Division
Hubert H. Humphrey Building
Room 717H
200 Independence Avenue SW.
Washington, DC 20201
SOCIAL SECURITY ADMINISTRATION
Social Security Administration
Office of Public Inquiries
Social Security Annex
6401 Security Boulevard
Baltimore, MD 21235
HUMAN
SERVICES
USA
Facts and Information Resources
HEALTH
OF
on Immunizations
OF
Many preventable illnesses and deaths are caused each year by infectious diseases. Be-
cause of immunizations, childhood diseases such as measles, mumps and rubella have
declined dramatically in recent years, but they remain problems among certain under-
immunized groups. All adults need vaccinations to protect them against tetanus (lockjaw).
The elderly and those with certain chronic diseases need to get immunized against the flu
and pneumococcal pneumonia.
Childhood Immunizations
With only four to five visits to a health-care pro-
vaccine was licensed in 1955, and an oral
vider, most children can be protected against eight
vaccine (first licensed in 1961) is now widely
diseases. But many preschool children, particularly
available. All States require schoolchildren to
in the inner cities, are not being adequately immu-
be immunized against polio.
nized. Lack of adequate immunization for measles
Measles and Rubella. Measles can lead to
caused a resurgence of this disease in 1989, the
complications in the respiratory and central
greatest increase in cases and deaths in more than a
nervous system, including bronchitis and ear
decade. Parents need to be informed about the
infections. It can be especially dangerous for
importance of immunizations in ensuring a healthy
children under 2 years of age who are under-
future for their children.
nourished. Rubella (German measles) is also
Diphtheria and Tetanus (Lockjaw). Diphtheria
usually mild, but it is very dangerous for a
is a dangerous and highly contagious disease. It
pregnant woman because it can cause multiple
can cause heart failure, permanent damage to
birth defects in the unborn child. Current
muscles, and death. Tetanus comes from germs
measles outbreaks can be divided into two
that are commonly found in the ground and
major patterns - preschool outbreaks and
that can grow when they get into wounds. It
school outbreaks. With younger children,
attacks the nervous system, causing muscle
better immunization coverage is necessary at
spasms and painful convulsions. With the
recommended ages. School outbreaks occur
availability of highly effective vaccines and
primarily in vaccinated children and require
school entry laws, no one attending school since
more aggressive revaccination strategies during
the early 1980s should develop tetanus or
outbreak control efforts. All States require
diphtheria. The major barrier to complete
schoolchildren to be immunized against
eradication of these diseases is failure to
measles and rubella.
immunize and provide "booster" shots for all
Mumps. Mumps causes painful enlargement of
children, adolescents, and adults.
the glands in front of the ears. Recent outbreaks
Pertussis (Whooping Cough). Pertussis affects
of mumps have occurred mostly in States
the linings of the air passages, causing cough-
without immunization requirements for
ing and noisy ("whooping") intake of breath.
mumps. Increased use of MMR (measles,
The majority of cases of pertussis occur in
mumps, and rubella) vaccine, particularly in a
children under the age of 5. Infants less than 6
2-dose schedule, should reduce the incidence.
months of age are at especially high risk since
Haemophilus Influenzae, Type b (Hib): "Hib"
optimal protection from the disease requires at
disease causes meningitis and other invasive
least three doses of the vaccine. The recom-
bacterial diseases such as pneumonia. It is
mended 4-dose primary schedule begins at 6 to
especially threatening to children under 5 years
8 weeks of age and ends with the fourth dose at
of age and particularly those 6 to 12 months of
15 to 18 months of age. In addition, a booster
age. The vaccine should be given routinely in
dose is needed before school entry.
infancy, starting at 2 months of age. Additional
Polio. Polio attacks the central nervous system
doses are given afterward, depending on the
and can cause paralysis. It has been virtually
particular vaccine used.
eradicated in the United States. The first polio
The Healthy Difference Program, U.S. Department of Health and Human Services
Adult Immunizations
Additional Information
Tetanus. Everyone, regardless of age, needs to
Resources
be vaccinated against tetanus. Persons who
Write to "Vaccinations," Information Services, Center for
have never received tetanus vaccine should get
Prevention Services (MS E-06), Centers for Disease
the 3-shot series as soon as possible. The
Control, 1600 Clifton Road NE., Atlanta, GA 30333.
booster shot should be received at 10-year
Centers for Disease Control, Public Inquiries, 1600
intervals such as ages 15, 25, 35, etc.
Clifton Road NE., Atlanta, GA 30333; (404)639-3286,
Influenza (Flu). Influenza can be dangerous for
(404)639-3534 for publications.
the elderly, those who are debilitated, and those
Identifies and defines preventable health problems
with heart or lung disease because it lowers the
and maintains active survéillance of diseases. Operates
person's resistance to other infections that may
information center that deals directly with the public or
refers them to appropriate offices for more technical
be fatal. The elderly are most likely to be
information. Assists State and local agencies in disease
seriously ill or to die from the flu or related
prevention and health promotion programs. Provides
complications. Usually, the flu season is from
information about malaria and other tropical diseases and
November to April. People over 65 years old
risk of infection through travel in areas wordwide.
and those with chronic illnesses should be
National Clearinghouse for Maternal and Child
vaccinated each year in the fall or early winter.
Health, Information Specialist, 38th and R Streets
Pneumococcal Pneumonia. Pneumonia infects
NW., Washington, DC 20057; (202)625-8410.
the lungs, causing difficulty in breathing. It can
Centralized source of information on maternal and
be fatal. Older persons are two to three times
child health, including rubella. Distributes directories of
more likely to get this type of pneumonia than
Federal programs and voluntary and professional
organizations in the field of maternal and child health.
the general population. Immunization is
recommended for anyone age 65 and over and
American Academy of Pediatrics, 141 Northwest
for those of any age with certain chronic ill-
Point Boulevard, P.O. Box 927, Elk Grove Village, IL
60009; (312)228-5005.
nesses. The pneumococcal pneumonia vaccine
Offers guidelines for childhood immunizations.
is usually only given once and may be given at
the same time as a flu shot. Pneumococcal
American College of Physicians, Independence Mall
pneumonia immunization is covered by Medicare.
West, Sixth Street at Race, Philadelphia, PA 19106-
1572; (800)523-1546, (215)351-2653.
Publishes many practice guidelines and opinions,
Side Effects
including Guide for Adult Immunization.
Vaccines are among our safest and most effective
National Institute of Allergy and Infectious Dis-
medicines. However, vaccines, like other medi-
eases, Office of Communications, Building 31, Room
cines, can cause side effects. These are usually mild
7A32, 9000 Rockville Pike, Bethesda, MD 20892;
(301)496-5717.
and brief, such as low fever, sore arm, or malaise
Answers inquiries about infectious diseases and
after taking the shot. Very rarely, they are serious.
distributes consumer publications on many topics,
For this reason, vaccines should be given only by
including influenza, immunizations, and the immune
qualified persons and only to those who need them.
system.
Any adult who receives a vaccine, or the parent of a
child, should be informed about the benefits and
Related Events
risks of the vaccine before being immunized.
Vaccines work best when they are given at the
National Adult Immunization Week is October 20-26,
1991. For more information, contact the National
recommended time and on a regular schedule. All
Foundation for Infectious Diseases, 4733 Bethesda
health officials agree that the benefits of vaccination
Avenue, Suite 750, Bethesda, MD 20814; (301) 656-0003.
are greater than the small risk of possible side
Child Health Day is October 7, 1991. Contact the
effects from the vaccine. If you have any further
Department of Health and Human Services, Bureau of
questions about immunizations, contact a doctor or
Maternal and Child Health and Resource Development,
the local health department.
Parklawn Building, Room 605, 5600 Fishers Lane,
Rockville, MD 20857; (301) 443-3163.
U.S. GOVERNMENT PRINTING OFFICE: 1991 0-865-291
Dr. Sullivan Says
Because we all care.
HAVE
CHILDREN
VACCINATED!!
Check this list for what your
children need and when.
2 Months Old - Vaccinations
(DTP, Polio, Hib)
4 Months Old - Vaccinations
(DTP, Polio, Hib)
6 Months Old - Vaccinations
(DTP, Hib - If your doctor recommends)
12 Months Old - Vaccinations
(Hib - If your doctor recommends)
15 Months Old - Vaccinations
(DTP, Polio, Measles, Mumps, Rubella, Hib - If your doctor recommends)
5 Years Old - Vaccinations
(DTP, Polio, Measles, Mumps, Rubella)
15 Years Old - Vaccinations
(Tetanus, Diphtheria)
For more information, contact:
HEALTHY
The Local Health Department
PEOPLE
A Community Health Center
The Visiting Nurses Association
A Doctor
You CAN Make
a Difference!
A Message from Dr. Louis Sullivan, Secretary, U.S. Department of Health and Human Services
Dr. Sullivan Dice...
Porque nos importa.
VACUNE A
SUS NINOS!!
Verifique esta lista
para determinar las vacunas
que necesitan sus hijos y
cuando las necesitan.
Niños de 2 meses - Vacunaciones
(DTP, Polio, Hib)
Niños de 4 meses - Vacunaciones
(DTP, Polio, Hib)
Niños de 6 meses - Vacunaciones
11
(DTP, Hib Si su doctor lo recomienda)
Niños de 12 meses - Vacunaciones
(Hib Si su doctor lo recomienda)
Niños de 15 meses - Vacunaciones
(DTP, Polio, Alfombrilla, Papera, Sarampión,
Hib Si su doctor lo recomienda)
Niños de 5 años - Vacunaciones
(DTP, Polio, Alfombrilla, Papera, Sarampión)
Niños de 15 años - Vacunaciones
(Tetano, Difteria)
Para más información llame:
HEALTHY
El Departamento de Salud de
su Comunidad
PEOPLE
El Centro de Salud de
su Comunidad
La Asociación de Enfermeras
Un Médico
You CAN Make
a Difference!
Un mensaje del Dr. Louis Sullivan, Secretary, U.S. Department of Health and Human Services
HEALTH&
OF
HUMAN
THE SECRETARY OF HEALTH AND HUMAN SERVICES
SECURITY
WASHINGTON, D.C. 20201
USA
Dear Colleague:
As part of the extended family of the Department of Health and
Human Services--as a grantee, field officer, or related
contributor--you can help me get the word out to those we serve
that "you can make a difference" in improving personal health
and the health of families and communities through positive
health behaviors and practices. This Department operates a
vast array of programs and services aimed at promoting health
and preventing disease, from prenatal clinics in the inner city
to nutrition programs in senior centers. But if Americans do
not also take personal responsibility for health, all that we
do will fall short of producing a healthier Nation.
Together we can help provide two key ingredients to the
acceptance of personal responsibility for health: sound
information and the reinforcement of our health messages from
credible sources in the community. This Department has many
health promotion programs with these aims. What we will be
doing over the next six months is to ask that you help extend
this information to the millions of Americans you serve, the
millions who often are at greater risk of injury or disease
than the general population. I will be sending you regular
bulletins on specific actions that people can take to
significantly reduce the risk of death and disease. Please
read this Guide carefully for more details about this
initiative and what you can do.
Providing people with vital information, supporting them with
critical services, and offering the human gesture of
encouragement can help them live longer, healthier lives.
I hope you will join me in this outreach campaign because "you
CAN make a difference--a HEALTHY difference!" Thank you.
Sincerely,
Louis
Sulleran
Louis W. Sullivan, M.D.
CONTENTS
Introduction to the Healthy Difference Program
1
Good News to Share: Preventing Disease and
Promoting Good Health Can Be a Matter of Choice
2
Suggestions for Using the Healthy Difference Bulletins
4
Guidelines for Duplicating Bulletins
5
A List of Information Resources on Immunizations,
Alcohol, Nutrition, Smoking, and Physical Activity
6
MESSAGES AND MATERIALS
You will receive, over the next six months, five Healthy
Difference bulletins from Secretary Sullivan with important
health messages (printed samples and reproducibles),
together with companion sheets, "Facts and Information
Resources," that summarize background information on
the following topics:
Topics
Distribution
1. Immunization
Enclosed
2. Alcohol
July
3. Diet
September
4. Smoking
October
5. Physical Activity
December
Dr. Sullivan says
You CAN Make a Difference
INTRODUCTION
The Healthy Difference Program
You CAN make a difference in your
able through the Department of
own health, and in the health of those
Health and Human Services and
you meet and serve in the course of
private sector organizations. In
your daily activities. This is what the
addition, you will be receiving mate-
Healthy Difference Program is about. It
rials about five important health
is an outreach initiative to communi-
topics over the next six months as
cate vital health messages through the
part of this program. These topics
U.S. Department of Health and
were chosen because they touch all of
Human Services (DHHS) network of
us as individuals, professionals, and
grantees, field offices, and related
members of families or communities.
TOPICS
outlets. Our network can reach the
Enclosed is the first of five Healthy
vast constituencies of DHHS with life-
Difference bulletins, each designed to
1. Immunizations
saving information about actions they
provide people with brief, practical
April-enclosed
can take on behalf of their own
guidance on important health issues.
health-and equally important, the
Although they are intended for
2. Alcohol (July)
health of their families and their
primarily educational purposes, the
communities.
topics covered may suggest other
3. Diet (September)
The program is straightforward. It
activities that can be taken to rein-
4. Smoking (October)
provides background information,
force the health messages. For ex-
simple materials to share with your
ample, the smoking cessation bulletin
5. Physical Activity
populations, and some ideas for
may lead an office to develop a new
(December)
related activities. It recruits you as
worksite smoking policy, or an
messengers of the news that people,
emphasis on exercise may stimulate
acting alone and together, can make a
the formation of a walking club at a
difference-a healthy difference.
community center.
This guide is designed to help you
The important thing is to pass the
tailor the Healthy Difference program
information along to the local or county
to your agency's or organization's
level if you are in a State agency, to
needs. It includes materials and
your clients or other audiences if you
information you can use right away
are at the community level. Whatever
for a variety of activities, plus infor-
approach you choose, remember:
mation about other materials avail-
"you CAN make a difference."
1
Dr. Sullivan says
GOOD NEWS TO SHARE
Preventing Disease and
Promoting Good Health Can
Be a Matter of Choice
Good health doesn't just happen. It
available, measles afflicted about
involves personal choices. The good
500,000 children a year and
news is that much of the disease and
caused about 500 deaths annually.
disability affecting Americans is
In 1952 alone, more than 21,000
preventable. Eating the right foods,
cases of paralytic polio were
getting enough exercise and rest, not
reported. These are all now
smoking, and drinking alcohol only
preventable.
in moderation or not at all are some
An unhealthy diet and an inactive
of the actions that Americans can take
life contribute to 300,000 to
to maintain good health. If the right
400,000 deaths each year. Poor
choices are made, then heart disease,
eating habits are related to five of
cancer, stroke, and traffic fatalities
the ten leading causes of death in
and other injuries-leading causes of
the United States, including heart
death-can often be prevented.
disease, some types of cancer,
What prevents good health? Delay
stroke, and diabetes.
in getting immunizations, unhealthy
diet, inadequate exercise, and risky
Smoking is responsible for one
behaviors such as smoking and abuse
out of every six deaths in America
of alcohol are major causes of poor
each year.
health. Here are some facts:
Alcohol use contributes to one-
half of all motor vehicle deaths.
In the 1950s, before vaccines were
SOME TIPS FOR GOOD HEALTH
PASS THEM ON!
Be sure children and adults get the vaccinations they need
Eat right and exercise regularly
Don't smoke
Don't drink alcoholic beverages if you are pregnant or
under legal age, or when operating dangerous
equipment or motor vehicles
If you are pregnant, see a doctor as soon as possible
2
You CAN Make a Difference
Everyone Needs the News
Basic information about healthy
Black Americans, Hispanics, Asians
choices is important to Americans of
and Pacific Islanders, and American
every background and at every age.
Indians and Alaska Natives are
Still, people with low incomes, as well
among these high-risk groups. Chil-
as some racial and ethnic minority
dren and older adults also have
groups, experience disproportion-
special health needs.
ately high rates of some preventable
Many of the health problems of
health problems, and their needs have
greatest concern to both the general
been considered in developing the
and high-risk populations are influ-
Healthy Difference messages.
enced by the five basic risk factors
focused on in the program:
Diet
Exercise
Smoking
Alcohol
Immunization
Cancer
Heart Disease
Unintentional Injury
Intentional Injury
Infant Mortality/
Low Birth Weight
Stroke
Homicide
Diabetes
*
Cirrhosis
Vaccine Preventable
*
Diseases
Pneumonia/Influenza
FOR MORE INFORMATION, SEE
THE LIST OF RESOURCES AT THE END OF THIS GUIDE.
3
Dr. Sullivan says
SUGGESTIONS
Using The Healthy Difference
Bulletins
For most uses, you will want to
Booklet
reprint the one-page bulletins from
Combine the information from all
the reproducible slicks (see Guidelines
five bulletins, along with local infor-
for Duplicating Materials). The design
mation about contacts and resources,
allows some space near the "Healthy
and print a Healthy Difference book-
Special Events:
People" logo for you to add your logo
let tailored to the special needs of
Plan special events
or the names and phone numbers of
your clients and community. Find a
and activities to
local contacts for more information or
local business to donate the design
services. Each bulletin can be used
services and printing.
reinforce the health
either as a handout, a poster, a mailer,
messages in the
or as the outline for a class, lecture, or
Newsletter Article
bulletins and dis-
article. Here are a few ideas to get
Use the bulletins and the accompa-
started.
nying fact sheets to create a column or
tribute the materi-
series of articles in your organization's
als there. For ex-
Posters
newsletter - or print them so that
ample, sponsor a
Reproduce the bulletins on bright
subscribers can reproduce them and
paper and post them in public places,
post them in their worksites and
vaccination clinic
especially places where people linger
communities.
and use the vacci-
(i.e., waiting rooms, libraries, or
cafeterias).
Special Events
nation handout; a
Plan special events and activities to
"fun run" and use
Handouts
reinforce the health messages in the
the physical activity
Distribute the bulletins at special
bulletins and distribute the materials
events, meetings, or other gatherings.
there. For example, sponsor a vacci-
handout; or a
nation clinic and use the vaccination
smoke-out day and
Background for Class
handout; a "fun run" and use the
Presentations
use the smoking
physical activity handout; or a
Use the bulletins to help prepare
smoke-out day and use the smoking
handout.
for an introductory class on health
handout.
promotion for your clients. Refer to
the topic resource lists (page 6) for
Coalition Building
additional materials. The bulletins
Identify other community groups
can be used as handouts.
and businesses and share resources to
work on joint projects and activities in
Mailers
any of these topics areas.
Send the bulletins to other agen-
cies, businesses, schools, or commu-
Media Relations
nity organizations so that they can
Propose a story or a talk show on
post them or distribute them to their
these health issues to your local
clients. Or you may want to distrib-
media contacts. Tell them what
ute them directly to the public, either
impact these health issues have on
in response to requests generated
your client population(s) and empha-
from publicity about the Healthy
size what can be done to improve
Difference program or to a list of
long-term health prospects. Use the
community members with whom you
bulletins and fact sheets as back-
work regularly.
ground information.
4
You CAN Make a Difference
GUIDELINES
Duplicating Bulletins
Duplicating your own bulk quanti-
cate the bulletins from the slick
ties of the Healthy Difference bulle-
reproducible version, or photocopy
tins allows you to get the quantity
them and the fact sheets. Because
you need at an affordable price. It
these materials do not have a copy-
also allows you the option of tailoring
right, all or part of the Healthy Differ-
them to your organization by adding
ence materials may be reproduced.
information such as an identifying
logo and name, program write-back/
The guidelines below can help you
call-back, or introductory letter from
decide whether to photocopy or print
a prominent official. You may dupli-
your materials:
Photocopying
Printing
When to use
When to use
When reproducing small quantities
When reproducing large quantities
(in general, under 500 sheets)
(more than 500 sheets)
Advantages
Advantages
Economical in small quantities
Increasing quantity decreases price
Convenient
per item
Quick turn-around time
Sharper reprint quality
Color paper available for variety
A wide variety of ink colors, and
Disadvantages
types and colors of paper are
Price per item stays the same
available.
regardless of quantity and may
Disadvantages
be higher for smaller copying
Needs to be scheduled in advance
machines etc.
Expensive in small quantities
5
Dr. Sullivan says
INFORMATION RESOURCES
Immunizations, Alcohol, Nutrition,
Smoking, and Physical Activity
Immunizations
Alcohol
Centers for Disease Control, Public
National Clearinghouse for Alcohol
Inquiries, 1600 Clifton Road NE.,
and Drug Information, P.O. Box 2345,
Atlanta, GA 30333; (404)639-3286,
Rockville, MD 20852; (800)729-6686,
(404)639-3534 for publications.
(301)468-2600.
Operates information center that deals
Gathers and disseminates current
directly with the public or refers them to
information on alcohol and drug-related
For additional informa-
appropriate offices for more technical
subjects. Develops resource materials
tion about the Healthy
information. Assists State and local
and distributes materials in bulk quanti-
agencies in disease prevention and health
ties to support local prevention and
Difference program,
promotion programs. Provides informa-
education programs. Publications catalog
contact your granting
tion about malaria and other tropical
available.
agency, or:
diseases and risk of infection through
National Highway Traffic Safety
travel in areas wordwide.
Administration, 400 Seventh Street
National Clearinghouse for Maternal
SW. (NTS-11), Washington, DC 20590;
ODPHP National
and Child Health, Information Spe-
(202)366-0123, (800)424-9393.
Health Information
cialist, 38th and R Street NW., Wash-
Provides technical and financial
Center (ONHIC), P.O.
ington, DC 20057; (202)625-8410.
assistance to State and local governments
Box 1133, Washington,
Centralized source of information on
and awards grants for highway safety
DC 20013-1133
maternal and child health, including
and to help combat drunk driving. Also
rubella. Distributes directories of Federal
works with private organzations to
Office of Minority
programs and voluntary and professional
promote a variety of safety programs.
Health Resource Center,
organizations in the field of maternal and
Offers brochures, booklets, fact sheets,
P.O. Box 37337, Washing-
child health.
and research notes.
ton, DC 20013-7337.
American Academy of Pediatrics, 141
National Commission Against Drunk
Northwest Point Boulevard, P.O. Box
Driving, 1140 Connecticut Avenue
Your local library or
927, Elk Grove Village, IL 60009;
NW., Suite 804, Washington, DC
public health clinic may
(312)228-5005.
20036; (202)452-0130.
also have good health
Offers guidelines for childhood
Public service organization formed on
information.
immunizations.
the recommendation of the Presidential
Committee on Drunk Driving. Assists
American College of Physicians,
State and local governments and the
Independence Mall West, Sixth Street
private sector in implementing the
at Race, Philadelphia, PA 19106-1572;
Commission's recommendations. Docu-
(800)523-1546, (215)351-2653.
ments and disseminates model preven-
Publishes many practice guidelines
tion and education programs.
and opinions, including Guide for Adult
Immunization.
National Council on Alcoholism and
National Institute of Allergy and
Drug Dependence, Inc., 12 West 21st
Street, Suite 700, New York, NY 10010;
Infectious Diseases, Office of Commu-
(800)NCA-CALL; (212)206-6770.
nications, Building 31, Room 7A32,
Combats alcoholism, other drug
9000 Rockville Pike, Bethesda, MD
addictions, and related problems. Pro-
20892; (301)496-5717.
grams include prevention and education,
Answers inquiries about infectious
information services, and publications.
diseases and distributes consumer
Sponsors National Alcohol Awareness
publications on many topics, including
Month and National Fetal Alcohol
influenza, immunizations, and the
Syndrome Week. Publishes and distrib-
immune systems.
utes an extensive list of educational
pamphlets and books. Publications list
available.
6
You CAN Make a Difference
National Safety Council, 444 North
Food and Drug Administration, Office
Michigan Avenue, Chicago, IL 60611;
of Consumer Affairs, 5600 Fishers Lane
(312)527-4800.
(HFE-88), Rockville, MD 20857;
Offers many safety education re-
(301)443-3170.
sources. Extensive publications catalog
Consumer materials on foods, food
available. Fact sheets, manual, and
processing, general nutrition, nutrition
audiovisual materials are available.
labeling, and nutrition fraud are available.
Students Against Driving Drunk
American Dietetic Association, 216
(SADD), P.O. Box 800, Marlboro, MA
West Jackson Boulevard, Suite 800,
01752; (508)481-3568.
Chicago, IL 60606-6995; (312)899-0040.
Addresses prevention of drinking and
Professional association offers profes-
driving. Offers community awareness
sional and consumer information on
programs, high school curricula, and
institutional nutrition programs as well
technical assistance in forming new
as guidelines for healthy personal nutri-
groups. Local chapters.
tion and sponsors National Nutrition
Month in March. State chapters.
Nutrition
American Heart Association, 7320
National Cancer Institute, Cancer
Greenville Avenue, Dallas, TX 75231-
Information Service, Building 31,
4599; (214)706-1220.
Room 10A24, 9000 Rockville Pike,
Consumer and professional materials
Bethesda, MD 20892; (800)4-CANCER.
on heart healthy nutrition, including
Consumer and professional materials
decreasing intake of dietary fat, choles-
available on diet-cancer link and making
terol, and sodium. Offers diet plans and
healthy choices about eating. Informa-
cookbooks. Materials generally available
tion available on "Eat for Health," a
through State and local affiliated chapters.
supermarket-based nutrition education
American School Food Service
program cosponsored by the institute.
Association, 1600 Duke Street, 7th
National Diabetes Information
Floor, Alexandria, VA 22314; (800)877-
Clearinghouse, Information Specialist,
8822.
Box NDIC, Bethesda, MD 20892;
Seeks to encourage and promote the
(301)468-2162.
maintenance and improvement of the
Consumer information on diabetes-
school food and nutrition program.
related topics, including diet and nutri-
Sponsors National School Lunch Week in
tion. Professional materials include
October. Distributes information on
bibliographies of patient education
school food and nutriton programs and
materials.
child nutrition legislation.
National Heart, Lung, and Blood
Center for Science in the Public
Institute, Information Officer, Building
Interest, 1501 16th Street NW., Wash-
31, Room 4A-21, 9000 Rockville Pike,
ington, DC 20036; (202)332-9110.
Bethesda, MD 20892; (301)496-4236.
Consumer advocacy organization
Produces annual kits presenting a
offers several publications on nutrition
collection of research, resources, and
topics. Small fee for publications; catalog
reproducible brochures on high blood
available free.
pressure and high cholesterol. Most
National Dairy Council, 6300 North
consumer requests referred to NHLBI's
River Road, Rosemont, IL 60018;
Information Center. (See page 8.)
(708)696-1020, (800)426-8271.
Food and Nutrition Information
Develops nutrition education pro-
Center, National Agricultural Library,
grams and materials for children in
U.S. Department of Agriculture, Room
elementary and high schools, consumer,
304, 10301 Baltimore Boulevard,
and professionals. Regional offices.
Beltsville, MD 20705; (301)344-3719.
Provides print and audiovisual materi-
Smoking
als for consumers (including children)
Office on Smoking and Health, Public
and professionals on topics in human
Information Branch, Park Building,
nutrition, food service management, and
Room 1-18, 5600 Fishers Lane,
food technology.
Rockville, MD 20857; (301)443-5287.
Conducts a wide range of public
7
Dr. Sullivan says
You CAN Make a Difference
information activities to educate the
hazards. Printed materials, films, and
American public and heighten their
other resource materials, including
awareness about the health hazards of
program materials, are available; some in
smoking and other forms of tobacco.
Spanish. Over 130 State and local Lung
Public and professional materials are
Associations provide and coordinate local
available on tobacco and smoking issues.
services.
Cancer Information Service, National
Cancer Institute, Building 31, Room
Physical Activity
10A24, 9000 Rockville Pike, Bethesda,
President's Council on Physical
MD 20892; (800)4-Cancer.
Fitness and Sports, 450 5th Street
Supplies information about cancer and
NW., Suite 7103, Washington, DC
cancer-related resources to the general
20001; (202)272-3430.
public, cancer patients, and their families,
Works with schools, clubs, recreation
including information on smoking
agencies, and major employers on
cessation and the health effects of tobacco
physical fitness and exercise program
use. Publications lists for consumers and
design and implementation. Produces
professionals are available. Some materi-
informational materials on exercise,
als are in Spanish.
school physical education programs,
National Heart, Lung, and Blood
corporate fitness, and physical fitness for
Instutite Education Programs Infor-
youth, adults, and senior citizens.
mation Center, 4733 Bethesda Avenue,
National Heart, Lung, and Blood
Suite 530, Bethesda, MD 20814;
Institute Education Programs Infor-
(301)951-3260.
mation Center, 4733 Bethesda Avenue,
Source of information and materials on
Suite 530, Bethesda, MD 20814;
major risk factors for cardiovascular
(301)951-3260.
health, including smoking. Disseminates
Disseminates public education materi-
public education materials and worksite
als and materials on worksite health.
health materials. Professional materials
Responds to information requests.
include heart and lung health at the
Provides consumer materials on a variety
workplace and smoking cessation pro-
of topics, including exercise and the heart.
grams. Publications list available.
American Alliance for Health, Physi-
American Cancer Society, 1599 Clifton
cal Education, Recreation, and Dance,
Road NE., Atlanta, GA 30329;
1900 Association Drive, Reston, VA
(800)ACS-2345, (404)320-3333, in
22091; (703)476-3461.
Atlanta, (212)382-2169 media office
Special programs include fitness for
(NY).
older persons, activity programs for the
Prepares and distributes consumer and
handicapped, and an exercise program
professional materials on many aspect of
for youth and adults. Promotes school
cancer prevention, control, and treatment,
health and physical education programs.
including health effects of tobacco use
Distributes professional materials.
and guides to smoking prevention and
National Association of Governors'
cessation. State and local chapters.
Councils on Physical Fitness and
American Heart Association, 7320
Sports, Pan American Plaza, 201 S.
Greenville Avenue, Dallas, TX 75231-
Capitol Avenue, Suite 440, Indianapo-
4599; (214)706-1220.
lis, IN 46225; (317)237-5630.
Prepares and distributes materials on
Coordinates national employee health
all aspects of cardiovascular health,
and fitness day. Provides registration
including smoking cessation. Profes-
packets and incentive items to those
sional and consumer materials generally
organizations interested in participating.
available through State and local affili-
YMCA of the USA, National Director,
ated chapters.
Health and Physical Education, 101
American Lung Association, Director
North Wacker Drive, Chicago, IL
of Communications, 1740 Broadway,
60606; (800)USA-YMCA, (312)977-0031.
New York, NY 10019-4374; (212)315-
Physical fitness and health programs
8700.
include fitness training and conditioning
National voluntary and health educa-
and group fitness programs for all ages.
tion agency emphasizes antismoking
A variety of brochures are available from
activities to prevent and control lung
over 2,000 local YMCAs.
8
If you make copies of this guide,
take the opportunity to insert local
resources for services and infor-
mation here.
The Healthy Difference Program
Messages for better health on five topics
from the U.S. Department of Health and
Human Services to all those it serves:
1. Immunization
2. Alcohol
3. Diet
4. Smoking
5.
Physical Activity
HUMAN SERVICES USA
&
HEALTH
OF
DEPARTMENT
WIC/IMMUNIZATION
DEMONSTRATION PROGRAM
GOAL
Evaluate the most cost-effective approaches for
improving vaccination levels
STUDY DESIGN
Two-year pilot project
Three broad types of interventions
1. Screening for immunization status and
vaccination in WIC clinics (2 sites)
2. Screening for immunization status and routine
referral
a. Off-site (2 sites)
b. On-site (1 site)
3. Educational message about the importance
of vaccination (1 site)
Control clinics - no new interventions (2 sites)
Computerized system for assessing vaccination status
Food Vouchers for 1 month instead of 2 until
immunizations are up-to-date
EVALUATION
Calculate vaccine coverage levels before and after
interventions
Calculate total direct cost of each intervention
Reported Measles Cases, United States, 1950-1990*
1,000
900
Measles - by year, United States,
1980-1990
30
800
25
700
20
Reported Cases (X 1,000)
600
licensed
Reported Cases (X 1,000)
15
Vaccine
10
500
5
0
400
80
82
84
86
88
90
Year
300
200
100
0
1950 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84 86 88 90
Year
*1990 provisional data.
Risk of Measles in Different Age Groups Before
and During the Current Epidemic, United States*
120
100
Incidence per 100,000 population
80
60
40
20
0
<1 Yr
1-4 Yr
5-9 Yr
10-14 Yr
15-19 Yr
>=20 Yr
Age at Onset
1981-89 (median)
1990
*Information based on age-specific measles incidence rates for period 1981-1989 vs. 1990.
Risk of Measles in Different Racial/Ethnic Groups
of Preschool Children, United States, 1990*
200
150
Cases/100,000 population
100
50
0
<5 years
White Non-Hispanic
Black Non-Hispanic
Hispanic
*Information based on measles Incidence rates from 16 States.
MISSED OPPORTUNITIES FOR IMMUNIZATION
Percent of Children Served by Social Services Programs Among
Unvaccinated Measles Cases Who Were Eligible for Vaccination*
44%
51%
17%
WIC
AFDC
Public Housing
USDA
HHS
HUD
37%
34%
64%
Food Stamps
Medicaid
Any Program
USDA
HHS
USDA/HHS/HUD
*Information based on 238-437 unvaccinated, but vaccine eligible, measles cases In 5 different U.S. citles.
THE WHITE HOUSE
Office of the Press Secretary
EMBARGOED FOR RELEASE
May 13, 1991
UNTIL 12:00 NOON C.D.T.
1:00 P.M. E.D.T.
MONDAY, MAY 13, 1991
FACT SHEET
IMPROVING HEALTH FOR INFANTS AND CHILDREN
Improving the health of infants and children is an important
objective of the Bush Administration. The prevention,
immunization and Healthy Start initiatives are a vital part of
the Administration's policy of investing in the future of our
nation's children.
I.
FOCUSING ON PREVENTION
Prevention offers the greatest opportunities for realizing a
healthier America. The Bush Administration is vigorously
pursuing a prevention strategy to realize that goal.
The Administration's approach to improving infant and child
health is part of this effort. Ten thousand of the nearly 40,000
infant deaths in America each year are preventable. Our
generation has a responsibility to ensure that young people get
as good a start in life as society can offer.
The Administration's Fiscal Year 1992 Budget recognizes the
value of investment in prevention and in children. The Budget
includes increased funding for:
increase
the supplemental nutrition program for
9.52%
Women, Infants, and Children (WIC);
breast and cervical cancer prevention;
52.4%
o
smoking cessation;
7.8%
physical fitness and nutrition programs;
13.9%
injury prevention;
13.3%
access to health care;
11.4%
2
o
lead poisoning prevention;
412.5%
substance abuse prevention;
5.1%
The Administration is also increasing evaluations of
prevention and children's programs to ensure that Federal
investments get the highest possible payoff.
Childhood Immunizations
Childhood immunizations are a vital prevention measure.
Every year since the 1981-1982 school year, 95 percent or more of
elementary students entering school are immunized against each of
the vaccine-preventable diseases. However, much more needs to be
done to protect pre-school children from vaccine preventable
diseases; low immunization levels among pre-school children have
led to measles outbreaks. In this regard:
O
For Fiscal Year 1992, the President has requested an
additional $40 million for the Centers for Disease Control's
immunization program for a total of $258 million -- an
increase of 19 percent over 1991. Federal funding for
immunizations has more than doubled since 1988.
Of this increase, $35 million will be targeted to increasing
immunizations of preschool children in low-income minority
populations.
O
Three pilot demonstration projects -- in Chicago, Jersey
City, and New York City -- are presently being funded to
test "one stop shopping" for the children of low-income
families needing immunizations.
II. IMPROVING INFANT HEALTH
The Administration's three-part strategy to improve infant
health and to attack the persistent tragedy of infant mortality
in the United States includes:
1.
Increasing prenatal care and nutrition services for low-
income pregnant women, focusing on treatment for damaging
behavior such as smoking, alcohol and drug abuse.
2.
Targeting services and programs to at least 10 communities
with exceptionally high infant mortality rates.
3.
Making the public, and especially would-be parents, aware of
the sad fact that the behavior of parents often contributes
to poor infant health.
3
Background
The U.S. has significantly reduced the infant mortality rate
-- cutting the rate in half since 1970 to an estimate of 9.1
deaths per ,000 live births in 1990. But the percent of low
birthweight babies (babies who are more likely to die or face a
lifetime of serious health problems) has remained essentially
constant. Tragically, black infants are more than twice as
likely to die as white infants. American Indian infants are 60
percent and Puerto Rican infants are 40 percent more likely to
die than white infants.
One of the largest causes of infant health problems is
individual behavior. For example, smoking during pregnancy leads
to 10 percent of infant deaths and 25 percent of low birthweight
babies; yet, over 20 percent of women continue to smoke during
pregnancy. Infant health problems are particularly acute in
communities overwhelmed by the near collapse of two-parent
families, by shortages of available services, and by the use of
crack cocaine and other illegal drugs in epidemic proportions.
The Administration's Initiative to Reduce Infant Mortality
1.
A broad-based effort to expand service use.
Early access to prenatal care is critical to improving
infant health, yet nearly 25 percent of mothers receive no
prenatal care during the first trimester of pregnancy. Over 6
percent of women receive no care at all or wait until the third
trimester to receive care.
As recently as 1988, some States set eligibility levels for
pregnant women as low as 15 percent of poverty. The President
proposed increasing that level, and signed legislation that would
make all pregnant women and infants-in families with incomes
below 133 percent of the poverty standard eligible for Medicaid,
an expansion that makes Medicaid available to more than two
million women when they become pregnant. The initiative seeks to
realize the potential for early prenatal care and also put in
place targeted treatment programs.
The health initiative seeks to increase the frequency with
which high-risk women seek prenatal care and develop new targeted
treatment programs through the following measures:
improving participation in Medicaid among eligible pregnant
women by 5 percent per year (60,000 women/infant pairs);
increasing the number of high-risk women who receive prompt,
adequate prenatal care in community and migrant health
centers;
4
increasing the number of pregnant women and infants who
obtain adequate nutrition and healthcare referrals through
the Women, Infants, and Children (WIC) supplemental
nutrition program; and
o
integrating smoking and drug abuse cessation programs into
public prenatal care and nutrition programs.
2.
Target areas worst-hit by high infant mortality rates.
While the infant mortality rate in the United States has
dropped in recent years, disparities between geographic regions
of the country remain great -- ranging from a rate of 6.9 deaths
of children less than one year old per 1,000 live births in
Anaheim-Santa Ana, California to 23.2 such deaths in Washington,
D.C. As part of the effort to reduce overall infant mortality,
significant effort and resources must be committed to those areas
where infant mortality rates are highest.
The Administration's Healthy Start initiative will target at
least 10 communities with exceptionally high infant
mortality rates. As announced in the April 17 Federal
Register, the Federal government will fund programs that
encourage high-risk women to seek more frequent prenatal
care, establish new targeted treatment programs, and develop
special initiatives that address non-financial barriers to
prenatal care. The Administration has requested $171
million in Fiscal Year 1992 to fund this program.
0
Programs in the targeted areas will be a testing-ground for
new strategies that will serve as models for other
communities throughout the country.
3.
A national public education campaign.
In 1985, only 54 percent of women aged 18-44 knew that heavy
drinking during pregnancy increases the chance of birth defects;
only 52 percent were aware that smoking during pregnancy
increases the chance of low birth weights. The health initiative
will try to get the message out by:
o
cooperating with the National Advertising Council, employers
and private insurers to stimulate free air-time for public
service announcements;
targeting educational messages to schools, hospitals,
community centers, business groups, and Healthy Mother-
Healthy Baby networks in each state;
5
distributing maternal and child health handbooks to all
pregnant women in publicly-funded programs;
providing information for expectant parents through a
national toll-free hotline that is linked to local health
care systems; and
developing a model program that encourages community
awareness and involvement.
# # #
PUBLIC HEALTH SERVICE
CDC - 1
CENTERS FOR DISEASE CONTROL
Immunization Budget Summary
Question:
What accounts for the $40 million increase in 1992 for the CDC
Immunization program?
Answer:
O Request of $258 million for the 1992 immunization budget is a
net increase of +$40 million, or +19%, over 1991.
O Most ($35 million) of this increase will be targeted to
increasing immunizations of children under 2-years-of-age,
particularly inner-city, minorities, who currently have the
lowest immunization rates and are the most vulnerable to adverse
effects of childhood diseases.
O These additional funds in 1992 will be used to:
-- Expand efforts to better coordinate immunization services
with other low-income assistance programs, e.g., WIC, AFDC,
and Medicaid; and improve outreach (+$9 M, total $24 M) ;
-- Help communities identify and eliminate current barriers to
immunizations (+$6 M, new) ;
-- Reward States and cities which show the most improvement in
the previous year in rates of immunization among low-income
2-year-olds (+$20 M, new).
Prepared by ASMB
A Shot in the Arm
M
EASLES AND other contagious child-
that prevent timely immunization, as a national
hood diseases, once all but eradicated in
advisory panel recommended earlier this year.
this country, are coming back at an
Some doctors and clinica, for example, choose
alarming rate. The 26,000 cases of measles
not to immunize unless an appointment has been
réported last year stand in sharp contrast with
made or until a physical exam has been complet-
the all-time low number (1,497) in 1983. Almost
ed. Many insurers do not cover the cost of
half the victims were preschoolers, for the most
immunization, which forces more parents to go to
part black and Hispanic inner-city children, who
understaffed clinics. The insurers' savings are
had not received the recommended vaccine for
dubious in the face of spreading disease; for
this potentially fatal illness.
every $1 spent on a vaccine, $10 is saved in
Specialists estimate that as many as half of all
future health care costs.
inner-city 2-year-olds fail to receive the immu-
To make it easier for parents, some cities are
nizations they need-one of the worst rates in
beginning to link vaccination programs with the
the Western Hemisphere. Parents-the working
delivery of welfare and other social services-a
poor, for the most part-either don't know to
good idea as long as it's not punitive. (In a New
take their children to the besieged public health
York pilot program, mothers whose children
clinics, don't know where to take them or simply
aren't immunized receive fewer vouchers for
can't take them. Many clinics have had to shut
food than those whose children are.) Here in
down evening operations and let go nurses, for
Washington, where mumps is more of a menace
instance, because of diminishing funds. Ironically,
than measles so far, the city offers vaccinations
the budget squeeze is caused in part by the rising
at the Reeves municipal center in the evenings
cost of the vaccines themselves-from about $7
and occasionally at "health corners" at public
per child in 1982 to $91 last year.
housing sites. Further public education would
The federal government has requested a $40
help too. The Association of Junior Leagues is
million increase in its immunization grant pro-
running a vaccination campaign in dozens of
gram, which pays for a quarter of all vaccines
cities, including this one.
distributed. The American Academy of Pediatrics
This country has the wherewithal to ensure that
thinks it will take far more to deliver enough
every toddler gets the vaccines he or she needs, and
vaccines. But everyone agrees it's going to take
Congress should see to it. Complacency, including
something other than money to stem outbreaks
the cessation of federal monitoring of preschool
like those occurring in New York, Philadelphia
immunizations (they'll be resumed this year), has led
and Los Angeles. Many barriers must come down
to contagion-and national embarrassment.
The Measles Epidemic: The Problems, Barriers and Recommendations
Adopted by the National
Vaccine Advisory Committee
January 8, 1991
EXECUTIVE SUMMARY
Despite exceptional progress made in the control of measles
since licensure of measles vaccines in 1963, the nation has
experienced a marked increase in measles cases and a number of
urban epidemics of measles during 1989 and 1990. Almost one half
of all cases have occurred in unvaccinated preschool children,
mostly among minorities. As serious as the epidemic itself may
be, the causes of the epidemic lead to even greater concern about
the nation's current system and capacity for delivering vaccines
to children.
The principal cause for the epidemic is failure to deliver
vaccine to vulnerable preschool children on schedule. Major
reasons for the low vaccine coverage exist within the health care
system itself which create barriers to obtaining immunization and
fails to take advantage of many opportunities to provide vaccines
to children when such children make health care visits. Many of
the barriers result from policies which require advance
appointments rather than providing immunization on request, and
policies that require comprehensive physician evaluations when
appointments for such evaluations may take weeks to months to
obtain. Other barriers result from insufficient State and local
resources resulting in inadequate nursing staff, clinic hours,
and clinic locations. The measles epidemic is a warning flag
about children's immunization status and the nation must respond
to this deficiency.
Ideally, immunizations should be given as one part of a
comprehensive child health care program. This is the ultimate
goal toward which the nation must strive if all of America's
children are to benefit from the best our health care system has
to offer. The lack of adequate resources represents a principal
barrier. However, the delivery of immunization, our most
cost-effective health service, cannot await the development of
the ideal comprehensive child health system. Essential changes
in the childhood immunization system can and should be made now.
Increased Measles Incidence in 1989-1990
O
During 1989, more than 18,000 measles cases -- the largest
number since 1978 -- were reported. This was more than ten
times the all-time low number of cases (1,497) reported in
1983. Measles caused 41 deaths in 1989, the largest annual
number of reported deaths due to measles in almost two
decades.
In 1990, the epidemic intensified, with more than 25,000
cases and over 60 deaths reported.
During 1989 and 1990, children younger than 5 years of age
have been at greatest risk. The increase in cases has been
greatest among preschool children, with 47% (provisional) of
the cases reported in 1990 occurring among this group.
2
Most children with measles reported in this epidemic were
unvaccinated. Current recommendations call for measles
vaccination at 15 months or before. As many as half of the
children living in low income, inner city neighborhoods have
not received measles vaccine by their second birthday. From
1989 through 1990, over 80 percent of measles cases among
children ages 16 months to 5 years could have been prevented
by timely vaccination.
Measles Increase is Indicative and Predictive of Other Problems
Measles serves as a measure of the efficacy of vaccine
delivery. The increase in measles cases is likely to be
followed by outbreaks of other vaccine-preventable diseases.
Missed Opportunities to Vaccinate are Part of the Problem
In some outbreaks, one-third of children with measles had
experienced at least one previous health care visit at which
an opportunity for vaccination was missed. Children fail to
be vaccinated because of policies which: (1) use unwarranted
contraindications such as minor illness to defer
immunization; (2) do not administer all needed vaccines
simultaneously but refer the child for multiple visits; and
(3) simply fail to assess the child's immunization status
and offer needed vaccines.
Many poor and minority children use acute care clinics and
emergency rooms as their primary source of care but aren't
immunized in this setting.
Children receiving benefits under publicly-funded programs
often do not receive immunizations on schedule. The
majority of unvaccinated vaccine eligible preschool children
with measles have been enrolled in public assistance
programs such as Aid to Families with Dependent Children
(AFDC), Medicaid, or the Supplemental Food Program for
Women, Infants, and Children (WIC).
Key Barriers to Immunization
Approximately half the country's public immunization
programs report one or more policy related barriers
including: (1) required advance appointments instead of
immunization on request; (2) required physical exams,
physician referral, or enrollment in comprehensive care well
baby clinics before immunization, when such services may
need scheduling weeks in advance; or (3) vaccine
administration fees.
Many immunization programs across the country have
inadequate resources, including insufficient clinic staff or
inadequate clinic hours. In addition, four programs report
having too few or inconvenient locations to reach
successfully the populations they are expected to serve.
3
Many insurers do not cover immunizations forcing
pediatricians and other physicians to pass on costs to
parents or to refer the parents to already overtaxed public
clinics. This leads to further fragmentation of care.
Key Recommendations
To prevent the health burden of measles and other vaccine
preventable diseases and ensure that the nation's children are
vaccinated at the appropriate age, the National Vaccine Advisory
Committee offers the following 13 recommendations. Many of these
recommendations require changes in policy for immunization
delivery and do not need increased resources for implementation.
Others, however, will require new resources. Based on a partial
examination of information, the Committee has made a provisional
estimate of resources to implement these recommendations. A net
increase of $40-50 million will be needed annually to implement
all of these recommendations.
Improve Availability of Immunization
1. Adequate Federal financial support should be provided to
State and local health departments to enhance the vaccine
delivery infrastructure (e.g., professional staff, community
outreach workers).
2. Vigorous efforts should be made including legislation, if
necessary, to assure that all managed care systems provide
immunization and that all third party payers cover routine
childhood immunization as part of their basic benefits
package.
3. Medicaid, including the Early Periodic Screening Diagnosis
and Treatment (EPSDT) program should assure that all covered
children receive vaccines by (1) tracking and assessing
immunization status, (2) assuring providers are adequately
reimbursed for vaccines and vaccine administration and (3)
making sure providers receive vaccines purchased through low
cost Federal contracts.
4. National and community level efforts should be enhanced to
build grassroots support for adequate resources for
immunization and to enhance local request for immunization.
Improve Management of Immunization Delivery
5. The National Vaccine Advisory Committee in collaboration
with public and private sector groups should issue a formal
set of minimum "Program Standards for Immunization
Practice." These standards should assure that immunization
is available on request at convenient times and that
children are not required to have comprehensive physician
evaluations when they are not readily available.
6. To improve access to care, the NVP-chaired "Intergovernmental
Coordinating Group on Access to Immunization" should develop
and implement a comprehensive plan to assure the clients
they serve are adequately immunized.
7. Immunization status should be assessed routinely for persons
enrolled in Women, Infants and Children (WIC) and Aid to
Families with Dependent Children (AFDC). Children in need
should either be offered vaccine on-site or referred for
vaccination with appropriate follow-up.
8. The NVP through CDC should collaborate with major health
care provider organizations to encourage the adoption of
policies which diminish barriers and take advantage of all
opportunities to vaccinate.
9. State and or local governments which have not as yet done so
should enact and enforce legislation to mandate appropriate
immunization prior to enrollment in licensed day care
centers.
Ongoing Measurement of the Children's Immunization Status
10. Preschool immunization coverage should be assessed annually
at the National and State levels and in high-risk urban and
rural areas.
Other Measles Prevention Needs
11. The two-dose schedule for measles, mumps, rubella vaccine
(MMR) should be implemented across the country. Additional
resources should be made available if current funds are
found to be inadequate.
12. A rotating fund for outbreak control should be established
to avoid the need for emergency appropriations to control
unforseen vaccine-preventable disease outbreaks.
13. Laboratory, epidemiology and field studies should be
conducted:
to determine more specifically the causes of low
immunization levels in different areas and cost-
effective interventions to improve coverage.
to assure (1) rapid diagnosis of measles to facilitate
outbreak control, (2) existing vaccines continue to
provide a high level of protection and (3) the two-
dose efficacy. schedule has the desired impact in enhancing
O
to develop vaccines that are safe and effective in
younger infants and, ideally, in newborns.
to develop vaccine combinations to decrease the number
of injections and visits required.
THE PROBLEM
Remarkable progress has been made in the effort to control measles
since 1963 when measles vaccines became available for use (Figure
1). However, during the past two years, measles cases and deaths
have risen sharply. During 1989, more than 18,000 cases and 41
deaths were reported, the largest number of reported cases since
1978 and the largest number of deaths in almost two decades. The
epidemic intensified during 1990 -- with more than 25,000 cases and
more than 60 deaths.
The current epidemic has hit the nation's youngest and most
vulnerable children hardest. The recent increase in cases has been
greatest among children younger than five years of age (Figures 2 &
3.). During 1989, outbreaks among preschool children predominated
with three inner-city epidemics (Chicago, Houston and Los Angeles)
accounting for one-third of all cases. This trend accelerated
during 1990, with nearly half of all cases occurring among children
less than five years of age. (Figure 3) Minority children are
disproportionately affected with Hispanic and Black preschool
children, particularly in urban areas, facing 7-9 times the risk of
measles as white children (Figure 4).
This represents a change from the mid-1980s when most measles cases
occurred among a small proportion of school and college age students
who had not been vaccinated or who had been vaccinated
unsuccessfully. Because vaccine failure remains a problem,
beginning in 1989 a second dose of vaccine was recommended to be
administered at entry either to primary or to middle or junior high
school. Since this is a long-term solution requiring 7-13 years to
reap the full benefits, aggressive revaccination during school-
based outbreaks will be needed in the interim.
Studies reveal no change in the effectiveness of the vaccine during
recent years. The vaccine, licensed and in use since 1963, protects
about 95% of those who receive it. About three-fourths of those
with measles during 1990 were unvaccinated (Figure 5). For this
unvaccinated group of children more than 17,000 cases could easily
have been prevented with the currently available highly safe and
effective vaccine.
-line
The principal "tause for the measles epidemic is failure to deliver
vaccine to children at the recommended age. Although immunization
levels are 97-98% at the time of school entry, they are reported to
be as low as 50% among 2-year olds in some inner city populations
(Figure 6). As a result, these vulnerable infants remain
susceptible and a highly contagious disease such as measles spreads
rapidly and widely. Limited data suggest the problem in
inner cities is not uniform and that some inner cities have achieved
coverage high enough to prevent significant transmission of measles
(Figure 6).
The measles epidemic is cause for serious concern. But measles,
being the most contagious of the vaccine preventable diseases, is
also an indicator that signals a failure in the vaccine delivery
system. Given low immunization levels among young children, it is
reasonable to suspect that there are substantial numbers of
children now also susceptible to pertussis, poliomyelitis, mumps,
and rubella. Likewise, Hemophilus disease, which is now preventable
by vaccination, continues to be a serious problem.
THE NATION'S CHILDHOOD IMMUNIZATION SYSTEM
The current childhood immunization system in the United States is a
patchwork of public and private sector efforts that include
participation of private physicians, and local, State and Federal
governments. The vaccination system consists of two major
components: (1) vaccine purchase and (2) vaccine administration to
children. Half of all vaccines are administered in the private
sector and half administered in the public sector.
Since 1963, the Federal government, through the Centers for Disease
Control has provided grants to States and some large county and city
health departments to assist with the purchase of adequate supplies
of vaccines and to supplement their immunization efforts. Federal
immunization grants currently support purchase of approximately half
of the total public sector vaccine needs, although the proportion
varies by specific vaccine. State and local resources are used to.
meet the remaining vaccine needs. Federal immunization grants also
support administrative activities such as: assessment of
immunization coverage; promotion of vaccination; and surveillance of
disease and adverse events.
Actual delivery of vaccines in the public sector is primarily a
State and local responsibility although Federal funds provide
support for delivery through Medicaid, the Maternal and Child Health
Block Grants, and the Prevention Block Grants to states and
designated localities and as Federal Grants directly to community
health centers. Although the total Federal resources being provided
for immunization are considerable, there is presently no formal
national coordination of the Federal role in vaccine delivery.
It is not possible to determine precisely how much money is used
for immunization. It is clear, however, from available evidence
that publicly-funded clinics are essential as a source of preventive
care for low income families and that many clinics lack the
resources to adequately serve all families in need of low-cost or
free immunizations.
WHY ARE CHILDREN NOT BEING VACCINATED?
The current vaccine delivery system is complex and varies from city
to city and state to state. There is no universal approach to reach
all children. Known barriers to successful immunization for all
children include four key types. Each can be addressed. They are:
missed opportunities for administering vaccines;
short-falls in the health care delivery system with barriers
to immunization;
inadequate access to care; and
8
incomplete public awareness and lack of public request for
immunization.
1)
Missed Opportunities to Vaccinate Children
Parents are often blamed for the poor immunization status of their
children, but the evidence suggests that the health care system must
assume substantial responsibility for failure to vaccinate. Many
opportunities to provide needed vaccines are missed. Two types of
missed opportunities are of particular importance:
(a) a child brought to a center for immunization is not vaccinated
because of inappropriate contraindications such as minor
illness or only one or two vaccines are given when, in fact,
others are also needed and should be given;
(b) a child in need of vaccination has contact with a health care
provider for other reasons but his immunization status is not
assessed and immunizations are not offered.
Studies of unvaccinated measles patients in some epidemics have
shown that about one-third of these children had one or more visits
at which an opportunity was missed for vaccination. Failure to
vaccinate in emergency rooms and acute care clinics is particularly
important because many inner-city children use such settings as a
primary source of care. National survey statistics for 1988 reveal
that infants in inner city areas were twice as likely as suburban or
rural infants to use such clinics (including hospital outpatient
clinics, other clinics and health centers, or emergency rooms).
Nearly half of all Black or Hispanic infants received routine care
in a clinic setting.
Although inner city preschool children are often described as "hard
to reach", many of these children are in regular contact with public
assistance programs which typically see enrolled families every
month. Opportunities exist through these programs to screen for
immunization and, where practical, vaccinate children on-site. This
is infrequently done, however, as each of the programs is
administered by different agencies. Recent investigations of inner
city measles outbreaks in Chicago, Dallas, Los Angeles, Milwaukee
and New York indicate that 40 to 91% of unvaccinated preschool
children who developed measles were enrolled in one or more public
assistance programs, most commonly Aid to Families with Dependent
Children (AFDC) (and consequently Medicaid), as well as the
Supplemental Food Program for Women, Infants and Children (WIC)
(Table 3).
The failure to adequately vaccinate many children currently
enrolled in public assistance programs suggests that many of the
potential benefits gained by recent expansions in Medicaid
eligibility to a much larger group of poor and near-poor
preschoolers may not be realized unless steps are taken to assure
immunization is an integral part of program activities. Nearly one
out of every three children younger than six -- more than 6 million
children in all can now be covered by Medicaid if their families
apply for medical assistance.
9
The lack of National coordination of vaccine delivery has lead to
fragmentation in policies and absence of centralized monitoring of
the impact of each Federal program involved with immunization.
Policies which maximize opportunities for vaccination at each clinic
visit may not be receiving the priority that is required because of
the absence of strong National coordination. Recognizing this need,
the Secretary of Health and Human Services has recently promulgated
nine strategic Program Directions, two of which use immunization as
an indicator of success:
(a) to improve the health and well-being of individuals through
improved preventive health care, which includes examining the
potential of expanding Medicaid coverage for immunization, and
(b) to improve access of young children and their families living
in poverty to a wide array of developmental and support
services, including health.
To improve integration of efforts to enhance immunization, the
"Intergovernmental Coordinating Group to Improve Access to
Immunization" of all agencies involved in vaccine delivery or
serving high risk populations has recently been formed. The Group
includes various HHS agencies and the Departments of Agriculture and
Housing and Urban Development.
2)
Shortfalls in the Delivery System - Barriers to Immunization
The Centers for Disease Control (CDC) surveyed immunization program
managers from 54 of the 57 largest immunization projects in May 1990
to identify barriers to low immunization levels among preschool
children. Only two states reported inadequate vaccine supplies in
the public sector for routine immunization of preschoolers, despite
the prevalent belief that this was a major problem. These
difficulties were subsequently resolved.
The major unsolved problems identified in this survey were
obstacles to vaccine delivery. Of the 54 immunization program
managers surveyed, half cited resource and/or policy barriers that
limited access to vaccinations in one or more communities in their
project areas. Policy barriers for these 27 projects included:
immunizations being available by appointment only (93%) ;
requirements for physical examination prior to immunization
(56%) ;
need for physician referral in order to be vaccinated (41%);
requirements for enrollment in well baby clinics in order to
be immunized (37%); and
administration fees (22%).
State and local resource problems which were cited included:
insufficient clinic personnel (70%);
inadequate clinic hours (56%) ; and
too few clinic locations (15%).
National survey data of Hispanic families report inconvenient
clinic hours and locations as leading barriers to care. Other
reported problems include cultural and language barriers between
local clinic personnel and some of the populations they serve,
compounded by inappropriate health educational materials. In brief,
many immunization settings are simply not user friendly.
In addition, many public sector clinics have inefficient
immunization record keeping systems which do not allow programs to
track or notify families routinely when vaccinations are due.
Computerized systems which would facilitate rapid assessment of
immunization and outreach are often absent.
11
Problems in the public sector are compounded by difficulties in
vaccinating children in the private sector. The high costs of
vaccines to private physicians are often passed on to parents (Table
1) because the majority of insurers fail to cover vaccination (Table
2). This plus concerns about liability has led some physicians to
discontinue immunization as an office-based service. (The recently
established National Vaccine Injury Compensation Program should
alleviate this problem.) This set of circumstances leads in turn to
greater fragmentation of care as private sector patients are forced
to seek immunizations in already overtaxed public clinics.
3) Inadequate access to care
Because many families have no ongoing relationship with a health
care provider, low immunization rates reflect, in part, inadequate
access to care. National survey statistics show that preschool
children from more affluent families (family incomes above $35,000)
were far more likely to have had a routine health care visit,
including prevention services, than were those children from
families with incomes below $10,000. In 1988, Black infants were
two to three times more likely than white infants to have had no
well-baby care or visits.
4)
Inadequate public awareness and lack of public demand for
immunizations
In some communities, the low demand for immunization and a limited
appreciation of the importance of beginning immunization in infancy
has been reported among parents who may be isolated from the Health
Care System. Low demand for immunization by such parents further
reduces immunization coverage levels.
VOLUNTEER PARTICIPATION IN IMMUNIZATION EFFORTS
Many parents of inner city preschool children, particularly those
from minority groups, lack information about the importance of
immunizing their children at the recommended ages. Public sector
agencies such as health departments often lack the resources and
expertise to develop, produce, and disseminate culturally sensitive,
linguistically appropriate, educational materials. Volunteer
organizations and other private sector groups can play a major role
in assisting health departments in effectively getting the
immunization message out. In addition they can help build local
support for the resources needed to enhance the immunization
services in their respective communities. Volunteer groups can also
help improve clinic efficiency by providing additional clerical and
nursing support to existing clinics.
12
To increase immunization levels rapidly, some cities, with the
assistance of volunteer groups, have attempted campaigns where
vaccines are offered in multiple sites outside of routine clinics
usually over a one to two day period. To date such approaches have
generally proved disappointing with only small proportions of the
estimated target populations vaccinated. Moreover, such campaigns
do not build the permanent improvements in the vaccine delivery
system essential to sustain the high coverage levels required to
provide present and future vaccines. While vaccination campaign
approaches may still be explored, volunteer efforts are more likely
to be productive if targeted toward permanent improvements in
vaccine delivery and appropriate record keeping.
STUDIES
Activities that could be expected to have a marked impact in
reducing measles cases include studies to develop vaccines that are
safe and effective at younger ages; studies to ensure that the
current vaccine continues to be effective; and studies to design
cost-effective ways to reach more children with available vaccine in
and out of the comprehensive health care system.
CONCLUSIONS
The major reason for the resurgence of measles is failure to
administer vaccines to children at the appropriate age. Studies are
underway by CDC and others to better assess the role of consumer
education and motivation, provider practices, and local agency
policies in contributing to low coverage. As these data become
available, strategies for vaccine delivery can be refined.
Available information, however, indicates that the major cause can
be found in the health care delivery system itself.
Parents who seek immunization for their children face many
obstacles. One barrier results from policies which make
immunization difficult to obtain, such as the need to schedule
appointments, enroll the child in a well-child care program or have
a prior physical examination which is not immediately possible.
Other barriers to vaccine delivery are inadequate numbers of clinic
personnel to provide vaccination and the scheduling of clinics at
inconvenient hours. Immunization services should be provided at all
times during weekday working hours and at times when working parents
can bring their children for services - evenings and weekends.
Providing adequate personnel to accomplish these goals is difficult
for large urban health departments in particular, most of which have
severe fiscal constraints caused by eroding tax bases and increasing
service demand. In addition, many opportunities are missed to
vaccinate children who interact with the health care system.
Finally, little effort has been made to enhance access of the
disadvantaged to immunization services through other public
assistance programs.
Immunization benefits not only the child who is vaccinated but
society as a whole. The vaccine-preventable diseases are contagious
and outbreaks among inner city infants and toddlers threaten not
only their health but the health of all susceptible children and
adults, whether they live in urban, suburban or rural areas.
Because disease in any part of this country is a threat to all,
Federal, state and local governments share responsibility for
improving deficient delivery systems.
Ideally, immunizations should be given as one part of a
comprehensive child health care program. This is the ultimate goal
toward which the nation must strive if all of America's children are
to benefit from the best our health care system has to offer. The
lack of adequate resources represents a principal barrier. However,
the delivery of immunization, our most cost-effective health
service, cannot await the development of the ideal comprehensive
child health system. Essential changes in the childhood
immunization system can and should be made now.
RECOMMENDATIONS
I. Improve Availability of Immunization
1. Additional Federal financial support should be provided
through immunization grants to State and local health
departments to enhance the vaccine delivery infrastructure
(e.g. professional staff, community outreach workers). These
funds should be distributed to areas most in need,
particularly large cities. New policies should assure that
resources are used to improve current immunization delivery
rather than to substitute for current State and local efforts.
2. Vigorous efforts should be made, including legislation, if
necessary, to assure that insurers provide or reimburse for
immunization as part of their basic health benefits package
and that all managed health care systems, including health
maintenance organizations, provide routine vaccination
services.
3. Medicaid, and its child health component, the Early and
Periodic Screening, Diagnosis, and Treatment (EPSDT) program,
should be integrally involved in tracking children in need of
immunizations and providing adequate reimbursement for the
service. Thus, Medicaid should assess immunization levels of
clients served by individual providers as a measure of quality
and to assure compliance with Federal EPSDT requirements.
Medicaid providers should either be given vaccine through the
public sector or should be adequately reimbursed for the cost
of purchasing vaccine and its administration. To reduce these
costs, vaccine used by Medicaid providers should be purchased
at low Federal contract prices.
State EPSDT programs should better comply with federal
guidance to: make aggressive efforts to enroll families;
recruit and retain health care providers; provide appointment
scheduling and transportation assistance; and establish a
recommended well-child visit schedule that follows the
guidelines of the American Academy of Pediatrics.
4.
Health Departments should reach out to volunteer groups and
community-based organizations to build grassroots support for
adequate resources for immunization and to enhance local
request for and prioritization of immunization. The current
National and community-level efforts to build public awareness
of the importance of preschool immunization and the efficacy
of vaccines and their safety should be intensified.
II. Improve Management of Immunization Delivery
5. The National Vaccine Advisory Committee (NVAC) should issue a
formal set of minimum "Standards for Immunization Practice" in
collaboration with the Interagency Coordinating Group (see
Recommendation #6) and private sector groups (see
Recommendation #8) for vaccine delivery. The minimum
standards of immunization practice for all public sector
clinics should include:
immunizations should be available on request without
required appointments;
immunizations should be given to all children who have no
known contraindications and appear to be in good health
without requiring routine physical examinations or
measuring temperatures;
each clinic should have a prominently posted list of
valid contraindications, and all providers should be
familiar with valid contraindications.
Accepted procedures for informing parents or legal
representatives regarding benefits, risks and
contraindications of vaccination should be followed in
all instances;
simultaneous administration of all needed vaccines should
be the norm;
adequate staff must be available to deliver needed
immunization services during routine working hours and,
where needed, at times more convenient to parents such as
evenings and weekends.
15
6.
The NVP-chaired Intergovernmental Coordinating Group on
Access to Immunization should develop and implement a
coordinated plan to ensure high immunization levels for
the clients they serve. Immunization coverage should be
used as one major indicator of the quality of services
delivered. Periodic reports of the group's activities
should be made to the NVAC. Appropriate Interagency
Coordinating Groups should also be formed at the Regional
and State levels.
7.
Federal participation is needed to support determination
of immunization status of WIC and AFDC recipients
particularly in urban areas. Children with incomplete
immunization should either be referred for vaccination
with appropriate follow-up or be vaccinated on-site in
WIC or AFDC clinics and offices. Projects which evaluate
the feasibility, effectiveness and cost-effectiveness of
approaches toward improving coverage in these populations
should be encouraged, including conjoint location of WIC,
AFDC and immunization services ("one-stop-shopping")-
Results of successful efforts should be brought to the
attention of all interest groups.
8.
The NVP should assure collaboration through CDC with
major health care provider organizations including the
American Academy of Pediatrics, the American Academy of
Family Physicians and other key physician and nursing
organizations to develop policies among their members to
facilitate immunization delivery. These groups should
participate in developing minimum standards for
immunization practice and a checklist of valid
contraindications for vaccination. Organization
endorsements should be sought especially for delivery of
immunizations outside of comprehensive care settings when
such care is either not available or difficult to obtain,
particularly in acute care settings and to encourage
members to take advantage of all opportunities.
9.
State and or local governments which have not as yet done
SO should enact legislation to mandate appropriate
immunization prior to enrollment in licensed day care
centers.
III. Ongoing Measurement of the Children's Immunization Status
10. National immunization coverage should be assessed annually
through the National Health Interview Survey. Immunization
coverage assessments are also required in all states and
should be conducted in high-risk urban and rural local areas.
The CDC should explore feasible and economical ways of
measuring immunization coverage of two year olds at State, and
local levels. Federal resources should be used to enhance
surveillance, particularly in high risk inner city areas, in
order to obtain better information on vaccine-preventable
diseases and so design the most appropriate control
strategies.
IV. Other Measles Prevention Needs
11. The two dose schedule, recommended as measles, mumps, rubella
(MMR) vaccine, should be fully implemented across the country.
Some cases of measles will occur in schools and colleges so
long as students have not received a second dose of vaccine.
In most areas, two age groups are being vaccinated each year
-- one school age group (either entrants to school or entrants
to middle or junior high school) and college entrants. The
1991 congressional appropriation allocated Immunization Grant
funds to purchase approximately one-half of the needed MMR
vaccine provided in the public sector. Additional funds
should be provided as required.
12. A rotating fund should be established for outbreak control so
that funds would always be immediately available. This would
eliminate the need to wait for emergency appropriations before
responding to an outbreak. Because the two-dose schedule is a
long term solution and its full impact will not be achieved
for perhaps 7 to 13 years, funds will be needed in the
meantime for re-vaccination during outbreak control.
17
V. Need for New Information
13. Optimal measles prevention requires greater knowledge about
how best to deliver vaccine and more information on measles
virus, measles disease, and measles vaccines.
More studies on immunization program operations and
outcomes should be conducted to help in designing the
most cost-effective measures to improve vaccine coverage
and to better understand the key barriers to full
immunization among preschool children, particularly
minority populations living in inner cities.
Innovations, ranging from small changes such as provision
of vaccine on an "express lane" walk-in basis, to use of
birth certificate information for tracking of infants by
computer, to better coordination of public programs,
should be tested for their ability to raise coverage.
Laboratory and epidemiologic studies should be conducted
to address both the problem of measles in highly
vaccinated populations and of measles in young children
Such studies should include:
development of techniques to rapidly diagnose
measles and to effectively measure protective
immunity;
studies of disease and vaccine strains to ensure
that existing vaccines continue to provide a high
degree of protection against circulating wild-type
measles;
studies on the response to a second dose of measles
vaccine delivered at various ages and intervals, and
other investigations to determine whether
implementation of the two-dose schedule will
eliminate measles in school-age populations; and
studies to develop vaccines capable of providing
long lasting protection when given to children 6-12
months old or younger.
18
Infants (younger than 12 months) accounted for about one out of
every eight cases reported in 1989 and 1990, and 30% of all cases in
preschool children. Currently, the age of measles vaccination is
often lowered from 15 to 12 months in cities at risk of preschool
measles, and to six months during large outbreaks. However,
vaccination at six months of age is less effective, due to
interference by maternal antibodies remaining in the infant's
system, and necessitates re-vaccination at 15 months of age. The
availability of measles vaccines that more reliably protect children
under 12 months of age would allow more effective control of
measles.
Many of the above recommendations can and should be implemented
without the need for new resources. For example, some policy
changes can be executed with existing funds and may have substantial
impact. Some recommendations such as having Medicaid assure
vaccines are purchased from low cost Federal contracts should
actually be cost saving. Nevertheless, some recommendations will
require new resources. To enhance the vaccine delivery
infrastructure, inner cities without sufficient nurses will need
funds to hire them. New staff will be needed to assess vaccination
in WIC clinics and AFDC offices. Funds will be needed to address
some of the key information needs. Accurate resource estimates for
implementing the above recommendations will need to be developed.
Based on a partial examination of available information, the
Committee estimates that implementation of all of the
recommendations will require a net increase of $40 to $50 million
annually.
19
TABLE 1
Prices for vaccines purchased through the Federal Government
contract versus representative catalog prices
Contract
Vaccine
Catalog
Price"
Price
DTP
$ 6.91
$10.65
HbCV (HbOC)*
$ 5.18
MMR**
$14.25
$14.71
OPV*
$24.07
$ 1.92
$ 9.74
*
As of January 7, 1991
**
Price per dose, catalog price is the price from the company that
has the Federal contract
+
Lederle Praxis Biologics
++ Merck, Sharp & Dohme
TABLE 2
Insurance Coverage for Basic Childhood Vaccination*
Type of Plan
1 Coverage
Employment-based with
conventional health insurance
45
Preferred Provider Organization
62
Health Maintenance Organization
98
*Source: Health Insurance Association of American Survey, 1989
Note: Based on national survey statistics for 1988 (Natitonal Health
Interview Survey on Child Health and Current Population
Survey), an estimated 15 to 17 percent of all children (9 to
11 million) and approximately 28 percent of poor children (2
to 3 million) were uninsured. As a result of legislation
enacted since 1988, an estimated 2 million children have been
made eligible for Medicaid coverage.
TABLE 3
City- or County-Specific Enrollment
in Federal Assistance Programs*
Program
Dallas
Milwaukee
Chicago
LA
NYC
Type
(n=160)
(n=128)
(n=71)
(n=38) (n=40)
Percent Enrolled
WIC
25
54
61
57
50
AFDC
19
86
NA
60
63
Food Stamps
31
NA
NA
51
53
Medicaid
22
NA
NA
45
75
Public Housing
12
26
NA
3
25
Any Program
40
91
61
71
78
Reported vaccine eligible preschool-aged measles cases
NA = not available
FIGURE 1
Reported Measles Cases, United States, 1950-1990*
1,000
900
Measles, by year -- United States
1980-1990
800
24
700
16
Reported Cases (X1,000)
Vaccine
Licensed
600
Cases (thousands)
8
0
500
1980 82 84 86 88 90
400
Year
300
200
100
0
50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84 86 88 90
Year
*Through week 51, 1990.
FIGURE 2
Age-Specific Measles Incidence - U.S.
1981-1989 and 1990*
Incidence per 100,000 population
120
1670%**
100
80
943%
60
40
583%
226%
233%
20
933%
0
<1 Yr
1-4 Yr
5-9 Yr
10-14 Yr
15-19 Yr
>=20 Yr
Age at Onset
1981-89 (median)
1989
Provisional 1990 data through week 51
Percent increase
FIGURE 3
Measles -- United States, 1974-1990*
Proportion of total cases by age group
100
80
#
Percent
60
+
+
+
+
*
40
20
0
1974
1976
1978
1980
1982
1984
1986
1988
1990
Year of Report
Preschool-age
+
School-age
Postschool-age
Provisional 1990 data through week 51
SEN: Br:Xerox lelecopier 7020 ; 4-10-91 ; 7:25AM
,
40405814337
2024723519:# 2
Dr Roper: The Association of Junior Leagues International (AJLI)
will kick off its national immunization promotional campaign at:
the:
National Press Club
529 14th St N.W.
Washington, D.C.
202/662-7500
East Room
on:
Thursday, April 18, 1991
at:
9:15-11:15 a.m.
Additional information is provided on the attached sheet provided
by AJLI
Walter A. Orenstein
SENT BY:Xerox Telecopier 7020 ; 4-16-91 7:25AM
4046391433-
20247235191# 3.
APR 15 '91 15:56 JUNIOR LEAGUE
P.2/3
DON'T WAIT TO VACCINATE
Preas Briefing on Childhood Immunizations
April 18, 1991, 9:00 a.m.
National Press Club
WHO:
Dr. Walter Orenstein, Director of Immunization, Centers for Disease
Control (CDC), will speak to the measles epidemic and barriers to
prevention of preschool children. Immunization of children for measles,
mumps, pertussis and other preventable diseases is mandatory for school
entry. But one quarter of all American preschoolers and one third of all AS MANY AS
1/2 of all
poor children are not fully immunized when protection is most crucial.
Suzanne Plihcik, President, Association of Junior Leagues
International (AJLI), will announce the launch of "Don't Wait to
Vaccinate," a public awareness campaign to educate parents that all
children should be fully immunized by the age of two. More than 220
Junior Leagues will implement targeted public education campaigns and
volunteer initiatives in coalition with health providers and vaccine delivery
systems in the public and private sectors.
WHY:
Measles has reached epidemic proportions 1497, in some locales. The number
of measles cases rose from a low of me 1,500/in 1983 to 26,527 cases in
1990. More than be people died last year from the viral infection. To
date, according to the CDC, there have been 1,749 cases of measles
reported. The United States is in the midst of a national health crisis.
WHAT:
The National Vaccine Advisory Committee recently recommended
volunteer community outreach programs as among the most important to
strategies for meeting the goals of the new major infant immunization
initiative. More than 220 Junior Leagues will implement targeted local
public education campaigns in collaboration with local, county, and state
health departments, local chapters of the American Academy of Pediatrics,
and local children's hospitals to reach undeserved populations in the
communities they serve.
WHEN:
Thursday, April 18, 1991. 9:00 a.m.
WHERE:
National Press Chub, East Room
529 14th Street, N.W., 13th Floor
CONTACT: For more information, contact Kelly Harris, #212/683-1515.
Packets containing official reported data on measles from the CDC and
other detailed information on immunizations will be available at the press
briefing.
SENT DI xerox rerecopier 7020 , 4-10-91 20AM
40400314337
2024723519:# 4
APR 15 '91 15:57 JUNIOR LEAGUE
P.3/3
DON'T WAIT TO VACCINATE
Press Briefing on Childhood Immunizations
April 18, 1991, 9:00 a.m.
National Press Club
AGENDA
I.
Liz Quinlan, Director of Communications, Association of Junior Leagues
International, Inc.
П.
Walter Orenstein, M.D., M.P.H. Director of Immunization,
Centers for Disease Control.
III.
Suzanne Plincik, President, Association of Junior Leagues
International, Inc.
PACKET CONTENTS
1.
Agenda
2.
Association of Junior Leagues International Fact Sheet
3.
Centers for Disease Control Mission Statement
4.
Immunization Fact Sheet
5.
Immunization Schedule
6.
Provisional Measles 1990 Data. Centers for Disease Control
7.
Barriers To Vaccinating Preschool Children. Orenstein, et al.
8.
The Measles Epidemic: The Problem, Barriers and
Recommendations. National Vaccine Advisory Committee.
9.
JUNIOR LEAGUE REVIEW
10.
Immunization Handout
SENT BY:Xerox Telecopier 7020 ; 4-16-91 7 7:20AM
4U40391433
)
P.2/2
11 791 13:08 JUNIOR LEAGUE
The Video
FINAL 4-11-91
Public Relations
Network
TO:
FAX:
ATTENTION: ASSIGNMENT EDITORS, MEDICAL PRODUCERS AND REPORTERS. MEDIALINK IS
OFFERING A SATELLITE INTERVIEW FOR YOUR APRIL 19, 1991 BROADCASTS:
"DON'T WAIT TO VACCINATE"
MEASLES, a disease that should be eradicated, is back in epidemic proportions. Reports from
the American Academy of Pediatrics (AAP), as well as the Centers for Disease Control (CDC)
indicate that measles outbreaks are once again on the rise and at a frightening rate. ("Measles
surged from an all-time low of 1,497 cases in 1983 to 18,000 cases in 1989 to 25,526 cases
in 1990, the greatest number in more than a decade." (USA TODAY].) Preschoolers are poorly
immunized. Approximately one quarter of all American preschoolers, and one third of all poor
children are not fully immunized when protection is most crucial. Furthermore, the law
vaccination levels may lead to a resurgence of other preventable diseases such as rubella and
whooping cough.
Suzanne Pliholk (pron, "Plislk") is the President of the Association of Junior Leagues
International. She can speak about Junior League volunteer initiatives for this campaign in
your community and is available by satellite from Washington, D.C. on April 19, 1991 from
11:30AM * 1:30PM EST. Ms. Plihcik will be joined by Dr. Walter Orenstein. Director of
Immunization at the Centers for Disease Control. They can address a variety of issues and
answer questions about this nationwide health crisis. First. should we view immunization as a
parent's responsibility or the government's, or should both "the system" and parents be held
accountable? Second, it has been argued that the U.S. healthcare system presents too many
barriers for parents attempting to fully immunize their child. since most clinics and doctor
offices require & physical exam in order for the child to receive the shots or boosters
(WASHINGTON POST). Third, the cost for vaccines has increased thirteenfold between 1982
and 1990 and presents another barrier, especially for low-income families. According to the
AAP, at one time the cost for immunization was about $6.89; the process now has 8 price tag of
$91.20. Moreover, most veccinations are not covered by insurance plans. Can community
outreach programs be instituted that could overcome these barriers and facilitate the
immunization process?
The goal of the Junior League's campaign is clear: to increase awareness that all children need to
be fully Immunized by the age of two. Too many parents associate immunization with getting
their preschooler prepared for kindergarten, when in fact children first require immunization
at two months. The interview guests can relay the latest statistics . how many cases of measles.
rubella and whooping cough have been reported nationwide thus far in 1991, as well as describe
local Junior League initiatives in this nationwide campaign. They can list the shots and boosters
that should be administered and at what age, and finally they can explain the different strategies
and proposels that have been suggested by Washington officials and members of the medical
community to combat what Dr. James E. Strain, Executive Director of the American Academy of
Pediatrics, described as a "national disgrace."
ONE-ON-ONE SATELLITE INTERVIEWS WILL BE AVAILABLE ON APRIL 19. 1901. PLEASE CALL
CASSANDRA LATES AT MEDIALINK (800)562-7315 OR (212)682-8300 TO BOOK A WINDOW.
708 Third Avenue
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